Managing medical complications and recurrence after surgery for Crohn's disease

Vedolizumab for Crohn's disease

INTRODUCTION

Crohn's disease (CD) is a chronic inflammatory disorder of unknown aetiology. Currently, approved therapies that include prednisone, anti-metabolites and TNF antagonists, are often ineffective and frequently cause adverse effects. As a result, patients with CD can develop serious complications that adversely affect quality of life. Consequently, new treatment options are needed.

AREAS COVERED

This review discusses the potential role of vedolizumab, a humanised monoclonal antibody that selectively blocks lymphocyte trafficking to the gut, for the treatment of CD. All randomised placebo-controlled trials that evaluated vedolizumab for the treatment of CD were reviewed and safety and efficacy data evaluated.

EXPERT OPINION

Vedolizumab is an effective and well-tolerated drug that is an important advance for the treatment of CD.

Prevention of postoperative recurrence of Crohn's disease: Tripterygium wilfordii polyglycoside versus mesalazine

OBJECTIVES

To explore effectiveness and safety of polyglycosides of Tripterygium wilfordii (GTW) and mesalazine (5-aminosalicylic acid [5-ASA]) in preventing postoperative clinical and endoscopic recurrence of Crohn's disease.

METHODS

In this prospective, single-centre, single-blind study, postoperative Crohn's disease patients in remission were randomized to receive 1 mg/kg GTW daily, orally, or 4 g 5-ASA daily, orally, for 52 weeks. Patients underwent physical examinations, ileocolonoscopies and biochemical analyses at baseline and weeks 13, 26 and 52, or when clinical recurrence was suspected. Outcome measures were proportion of patients showing clinical or endoscopic recurrence at week 52, and changes in Rutgeerts' and Crohn's Disease Activity Index (CDAI) scores.

RESULTS

Twenty-one patients were assigned to receive GTW and 18 to 5-ASA; two patients on GTW and one on 5-ASA were withdrawn. Clinical and endoscopic recurrences were less common in the GTW group (n = 4) versus the 5-ASA group (n = 9). There were improvements in Rutgeerts' scores for those taking GTW. Mean between-group CDAI scores were similar. No serious adverse events were reported.

CONCLUSION

These findings indicate that GTW appears to be an effective, well-tolerated prophylactic regimen, superior to oral 5-ASA, for preventing clinical and endoscopic recurrence in postsurgical Crohn's disease.