Recurrence Of Crohn's Disease After Surgery Prevented By Remicade
Dr Miguel Regueiro and colleagues found Remicade (infliximab) to effectively prevent Crohn's disease relapse after resective surgery. Remicade prevented endoscopic, clinical, and histologic recurrence of Crohn's disease for 1 year after surgery.
In addition to indications for rheumatoid arthritis and other arthritic diseases,Remicade is approved for moderate to severe Crohn's patients who haven't responded well to other therapies.
The study published in the February issue of Gastroenterology was a small trial of 24 patients. These patients were enrolled in the study within four weeks of surgery to remove diseased portions of their bowel. They were given infusions of Remicade at 5 mg/kg -- or an identical-appearing placebo -- in the first, second, and sixth weeks, followed by infusions every eight weeks for 54 weeks.
The authors chose the primary endpoint as endoscopic recurrence (the five-point Rutgeerts scale). The researchers also looked at secondary endpoints, including clinical remission and recurrence (using the Crohn's Disease Activity Index) and histologic recurrence.
Those getting the drug Remicade had significantly lower rates of recurrence on all three (endoscopic, clinical and histologic) scales.
The rate of endoscopic recurrence was 9.1% in the Remicade group (one of 11 every patients) compared with 84.6% in the placebo group (11 of every 13 patients).
Markedly more Remicade patients (81.8%) had no evidence of Crohn's on colonoscopy compared with 7.7% of those given placebo.
None of the Remicade patients had a clinical recurrence compared with 38.5% of those on placebo.
Histologic recurrence was also lower in the Remicade group, where 27.3% had evidence of neutrophil infiltration compared with 84.6% in the placebo group.
Dr. Regueiro and colleagues said it gives "strong evidence" that the drug is effective and "provides a rationale for aggressive postoperative chemoprevention with biologic therapy."
It is important to remember that this is a very small study group. Follow up studies will need to be done.
For more information on Crohn’s disease visit the website of the Crohn’s and Colitis Foundation of America.