Biologic Prophylaxis Reduces Postoperative Recurrence in Crohn’s Disease
Biologic prophylaxis significantly reduces the risk of early postoperative recurrence following ileocolonic resection in Crohn’s disease (CD), according to a prospective multicenter study evaluating clinical predictors and long-term outcomes. The findings support routine risk stratification and early intervention after surgery.
The study included 632 adults undergoing ileocolonic resection, with a median disease duration of 7.8 years. Most patients (78%) had prior biologic exposure, and 44% received postoperative biologic prophylaxis. The primary endpoint was endoscopic recurrence within one year, defined as a modified Rutgeerts score of at least i2b.
Endoscopic recurrence occurred in 37.5% of patients. Multivariable analysis identified several independent risk factors, including male sex, active smoking, prior ileocolonic resection, and prior biologic exposure. Patients previously treated with one or more biologics had more than double the risk of recurrence compared with biologic-naïve patients.
Biologic prophylaxis was strongly protective. The authors reported that “biologic prophylaxis significantly reduced recurrence risk,” with an odds ratio of 0.31, independent of baseline risk factors. This effect was observed across patient subgroups, suggesting broad benefit regardless of individual risk profile.
A predictive model incorporating clinical variables demonstrated moderate accuracy, with an area under the curve of 0.72, and was validated in external international cohorts. Long-term outcomes showed that clinically significant recurrence increased over time, reaching 53.2% at 10 years. Early endoscopic recurrence was associated with worse long-term disease progression.
The authors concluded that “postoperative recurrence risk can be estimated using a model based on clinical factors,” and emphasized that “biologic prophylaxis is highly effective in preventing early endoscopic recurrence, regardless of risk profile.”
Reference
Allez M, Bak MTJ, Brand S, et al. Development and external validation of a predictive model for postoperative recurrence of Crohn's disease in the biologic era. Clin Gastroenterol Hepatol. Published online March 27, 2026. doi:10.1016/j.cgh.2026.03.015
