Infliximab vs azathioprine after ileocolic resection

What is known

• In a 26-patient prospective pilot, no infliximab patients vs 38% of azathioprine and 70% of mesalamine patients had endoscopic progression over 6 months. ¹
• A separate placebo-controlled RCT (early postop infliximab within 4 weeks, continued 1 year) used 1-year endoscopic recurrence as its primary endpoint, but the comparator was placebo, not azathioprine. ²
• The PREVENT RCT found infliximab reduced endoscopic but not clinical recurrence after ileocolonic resection; an open-label pilot compared azathioprine vs infliximab for postop prophylaxis. ³

What is unknown / caveats

• Closest direct comparison ¹ is a small pilot (n=8 per arm) in patients selected for existing 6-month recurrence, not primary postop prophylaxis
• No retrieved head-to-head RCT of infliximab vs azathioprine reporting 12-month endoscopic recurrence
• The only direct infliximab-vs-azathioprine endoscopic data retrieved come from a single small pilot, and its endpoint is 6-month progression after established recurrence rather than 12-month primary prophylaxis.

References

1. Yamamoto T, Umegae S, Matsumoto K. Impact of infliximab therapy after early endoscopic recurrence following ileocolonic resection of Crohn's disease: a prospective pilot study. Inflamm Bowel Dis. 2009;15(10):1460-6. PMID: 19266566.

2. Regueiro M, Schraut W, Baidoo L, Kip KE, Sepulveda AR, Pesci M, Harrison J, Plevy SE. Infliximab prevents Crohn's disease recurrence after ileal resection. Gastroenterology. 2009;136(2):441-50.e1; quiz 716. PMID: 19109962.

3. [No authors listed]. Perioperative management of ileocecal Crohn's disease in the current era. Expert Rev Gastroenterol Hepatol. 2020;14(9):843-855. PMID: 32729736.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.