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.