Timing of biologic prophylaxis and postoperative recurrence in Crohn’s disease: A real-life cohort study using propensity score weighting

Background Postoperative recurrence is a major challenge in the management of Crohn’s disease after ileocolonic resection. Although international guidelines recommend early initiation of biologic prophylaxis, the optimal timing remains uncertain in real-world practice. Methods We conducted a retrospective cohort study of Crohn’s disease patients undergoing ileocolonic resection. All patients received biologic prophylaxis within 16 weeks after surgery. Patients were stratified into 3 timing groups: <8 weeks, 8 to 12 weeks, and >12 and ≤16 weeks. To account for baseline differences, a propensity score–based inverse probability of treatment weighting approach was applied. The primary outcome was endoscopic recurrence (ER) at 6 to 12 months. Results Among 173 patients, 79 (46%) initiated biologic prophylaxis within 8 weeks after surgery, 32 (18%) between 8 and 12 weeks, and 62 (36%) between >12 and ≤16 weeks. ER at 6 to 12 months occurred in 103 (59.5%) patients. In the inverse probability of treatment weighting–weighted analysis, initiation of biologic therapy more than 12 weeks after surgery was associated with a significantly higher risk of ER compared with initiation within 8 weeks (risk ratio, 1.96; 95% confidence interval, 1.45-2.65; P < .001), whereas no significant difference was observed between initiation within 8 weeks and 8-12 weeks (risk ratio, 1.44; 95% confidence interval, 0.93-2.23; P = .10). In multivariable logistic regression analysis, smoking, prior intestinal resections, and delayed initiation of biologic prophylaxis were independently associated with ER. Conclusions In half of patients, prophylactic biologic therapy was initiated more than 8 weeks after ileocolonic resection. Initiation of biologic prophylaxis beyond 12 weeks after surgery was associated with a significantly increased risk of ER.