Anti TNF's for postoperative recurrence of Crohn's disease: the state of the art

Since Crohn's disease patients often undergo surgery and the diseaseoften recurs after surgery, prevention of such complication is animportant treatment consideration. Of those patients who developendoscopic recurrence the majority will develop symptomatic recurrenceas well, and may require a further resection. Although regularly prescribed, to date there has been little evidenceto demonstrate robust effectiveness of conventional medical therapiessuch as antibiotics, mesalazine, methotrexate and thiopurines in theprevention of Crohn's disease recurrence after resection.While much research has been published on the outcomes of antiTNF's in the treatment of moderate to severe Crohn's disease less is known with regard to its efficacy in preventing postoperative recurrence.Recently, promising data have been published on the use of anti TNF's inthe early post operative period, as a prophylaxis for recurrence. Outcomesof these initial studies have demonstrated that post operative recurrencecan be prevented in between 90 and 100% of patients. Large randomizedclinical trials are in progress seeking to confirm these findings on a largerscale. The results of these studies may change the paradigm formanagement of this complex disease in the future. In this chapter, afterreviewing the main features and risk factors for the development ofrecurrence we will focus on the medical therapy and especially on the antiTNF's used to prevent it. Finally, the available data on long term strategyto maintain clinical and endoscopic remission in patients on anti-TNFwill be discussed together with the main open issues