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Loss of Efficacy to Anti‐TNF Therapy in the Management of Crohn's Disease: A Brazilian Multicenter Observational Study: P‐127

resection, disease type, extent of disease, perianal disease, smoking habit, and postoperative treatments were also reviewed, and possible contribution of clinical factors to postoperative recurrence was analyzed. RESULTS: During the mean follow-up period of 29.6 6 19.2 months, postoperative recurrence was defined to be positive in 23 of 44 patients. Active inflammatory lesions were detected in the anastomotic site in 13 patients, outside the anastomotic site in 6 patients, and both in 4 patients. Postoperatively, 23 patients were treated by scheduled infliximab (5 mg/kg, every 8 weeks) and 2 patients were treated by adalimumab (40 mg, every other week). Univariate analysis using Logrank test revealed that history of intestinal resection (P 1⁄4 0.017) and current smoking habit (P 1⁄4 0.007) were more frequent in patients with recurrence than in those without. In addition, recurrence was less frequent in patients with antiTNFa monoclonal antibody than in those without (P 1⁄4 0.006). Multivariate analysis using Cox proportional hazards model demonstrated that patients treated with anti-TNFa monoclonal antibody were less likely to recur (RR 1⁄4 0.09. 95%CI; 0.02-0.34), while patients with history of intestinal resection had an increased risk of recurrence (RR 1⁄4 8.54, 95%CI; 1.79-60.36). CONCLUSION(S): Anti-TNFa monoclonal antibody treatment after intestinal resection obviously improves postoperative clinical course in patients with CD. Postoperative prophylaxis by biologic therapy might be appropriate for patients requiring repeated surgery in consideration of their higher recurrence rate.