The superiority of anti-TNFα agents to thiopurines for the prevention of postoperative recurrence of Crohn’s disease (CD) after ileocolonic resection remains controversial. In this meta-analysis of individual participant data (IPD-MA), the effect of both strategies was compared and assessed after risk stratification.
After a systematic literature search, IPD were requested from randomized controlled trials investigating thiopurines and/or anti-TNFα agents after ileocolonic resection. Primary outcome was endoscopic recurrence (ER) (Rutgeerts’ score ≥i2) and secondary outcomes were clinical recurrence (CR) (HBI/CDAI score) and severe endoscopic recurrence (SER) (Rutgeerts’ ≥i3). A fixed effect network meta-analysis was performed. Subgroup effects were assessed and a prediction model was established using Poisson regression models, including sex, smoking, Montreal classification, CD duration, history of prior resection and previous exposure to anti-TNFα or thiopurines.
In the IPD-MA, 645 participants from 6 studies were included. In the total population, a superior effect was demonstrated for anti-TNFα compared to thiopurine prophylaxis for ER RR 0.52 (95%CI 0.33-0.80), CR RR 0.50 (95%CI 0.26-0.96) and SER RR 0.41 (95%CI 0.21-0.79). No differential subgroup effects were found for ER. In Poisson regression analysis, previous exposure to anti-TNFα and penetrating disease behaviour were associated with ER risk. The advantage of anti-TNFα agents as compared to thiopurines was observed in low and high risk groups.
Anti-TNFα is superior to thiopurine prophylaxis for the prevention of endoscopic and clinical postoperative CD recurrence after ileocolonic resection. The advantage of anti-TNFα agents was confirmed in subgroup analysis and after risk stratification.

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