Introduction Follow-up of patients resected for Crohn’s disease (CD) have shown that in the absence of treatment, the post-operative recurrence rate is 70–90% within one year of the operation and 83–100% within 3 years. Prophylactic medication and disease monitoring has been proven to decrease the rate of clinical and endoscopic recurrence.
Method We aimed to examine current practices in our large tertiary referral centre on postoperative prescriptions of disease modifying therapy for CD. We performed a retrospective analysis by interrogating the pathology database over a five year period from 2009 to 2013 to identify cases and data was extracted by chart review.
Results 152 resections were identified. 106 patients had been given disease-modifying therapy. 3 patients were involved in a drug trial and were excluded. 66.3% of patients had therapy commenced before the first followup colonoscopy or imaging had been performed. As first-line 79 patients had thiopurine monotherapy (64 azathioprine, 14 mercaptopurine, 1 tacrolimus). 11 patients had anti-tnf monotherapy (8 adalimumab, 2 infliximab, 1 certolizumab). 13 had combination therapy with an immunomodulator and an anti-tnf. The outcomes are outlined in Table 1.
Conclusion While there is no clear benefit observed for drug therapy over no drug therapy, it is likely that those who receive no treatment have a selection bias of clinically silent disease or negative initial followup investigations. Among those in whom disease-modifying therapy is prescribed there is a trend for those on combination therapy to have a better clinical response as well as steroid free, repeat-resection free survival at end of followup.
Disclosure of interest None Declared.