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The long-term prognosis of Japanese patients with Crohn’s disease (CD) treated by switching anti-tumor necrosis factor-α (anti-TNFα) antibodies remains unclear.   Objective:   This study aimed to clarify the long-term prognosis and clinical factors that affect the long-term prognosis and outcomes of such patients.   Methods:   This retrospective, observational, single-center cohort study analyzed Japanese patients with CD treated by switching between infliximab and adalimumab in the Tohoku University Hospital between March 2003 and December 2017. Cumulative relapse-free survival and cumulative surgery-free survival rates were analyzed using the Kaplan-Meier method. Clinical factors that affected the long-term outcomes were identified using both a log-rank test and the Cox proportional hazards model.   Results:   The cumulative relapse-free survival rates were 68.6, 33.7, and 22.9% at 1, 3, and 5 years, respectively. The surgery-free survival rates were 91.7, 75.7, and 57.4% at 1, 3, and 5 years, respectively. The cumulative relapse-free survival rate was significantly higher in the group with ileal lesions (HR = 0.12; 95% CI 0.0066–0.64,  p  = 0.0086), stricture (HR = 0.24; 95% CI 0.0094–0.59,  p  = 0.0021), and a penetrating type (HR = 0.34; 95% CI 0.14–0.84,  p  = 0.020). Intolerance (HR = 0.29; 95% CI 0.12–0.63,  p  = 0.0013) and switching after surgery (HR = 0.41; 95% CI 0.17–0.87,  p  = 0.019) were clinical factors that reduced the risk of recurrence. The cumulative surgery-free survival rate was significantly higher in the group that switched after surgery (HR = 0.28; 95% CI 0.074–0.91,  p  = 0.034) and used concomitant thiopurine (HR = 0.32; 95% CI 0.10–0.90,  p  = 0.030).   Conclusion:   We should clarify the reason for switching anti-TNFα antibodies and investigate bowel complications before switching. Surgical reset of bowel complications including stricture and fistula could reduce the risk of recurrence after switching anti-TNFα antibodies. Concomitant thiopurine administration might reduce the risk of bowel surgery after switching anti-TNFα antibodies.

Long-Term Prognosis of Japanese Patients with Crohn’s Disease Treated by Switching Anti-Tumor Necrosis Factor-α Antibodies