Drugs That Help Stop Crohn’s from Coming Back After Surgery
A network meta-analysis of 34 RCTs (3,197 patients) found adalimumab cut clinical relapse after Crohn’s surgery (RR 0.31; moderate certainty). Vedolizumab likely lowered endoscopic relapse (RR 0.37; moderate certainty); adalimumab may also lower endoscopic relapse. 5-ASA and purine drugs showed small effects. Postoperative maintenance should be tailored to patient risk and treatment profile.
About half of people with Crohn’s disease need surgery at some point, and many face the worry that the disease will come back afterward. Doctors try different medicines to stop recurrence, but it has not always been clear which ones work best.
Researchers pooled data from 34 randomized trials with 3,197 patients to compare treatments used after surgery. They looked at return of symptoms (clinical relapse) and signs of disease on scope tests (endoscopic relapse). The review used modern methods to rank treatments by benefit.
Adalimumab stood out for cutting the risk of clinical relapse. Patients taking adalimumab were much less likely to have symptoms return compared with placebo. The evidence for this benefit was rated as moderate quality.
For what shows up on scope tests, vedolizumab probably did the best job. It lowered the chance of endoscopic relapse with a fairly large effect and moderate-quality evidence. Adalimumab also may lower endoscopic relapse, but the certainty was lower.
Some older drugs, like 5-aminosalicylic acid and purine analogues, showed only tiny reductions in clinical relapse and the evidence was weak. Most other therapies had very low certainty, meaning we can’t be sure they help.
What this means for patients is that adalimumab and vedolizumab are the most reliable choices based on current trials, but decisions should be personal. Doctors will weigh each person’s risk of relapse, side effects, insurance or cost, and monitoring plans.
Patients should talk with their care team about pros and cons. Using these drugs after surgery may lower the chance Crohn’s comes back, but the best choice depends on the patient’s health, values, and goals.