Clinical Impact of Sonographic Transmural Healing After Anti-TNF Antibody Treatment in Patients with Crohn's Disease.

Abstract

AIM:

To assess the clinical benefits of transmural healing (TH) shown on intestinal ultrasound (IUS) after treatment with tumor necrosis factor-alpha antibodies (anti-TNF) in patients with Crohn's disease.

MATERIALS AND METHODS:

This prospective study included consecutively 36 patients who underwent IUS in the week prior to start anti-TNF treatment, at 12 weeks, and 1 year after starting treatment. The clinical response to treatment was assessed using the Crohn's disease activity index and C-reactive protein (CRP) values. TH was defined as the normalization of bowel wall thickness on IUS. Treated patients were considered to have a good outcome if none of the following situations presented: need to reintroduce corticosteroids or intensify maintenance therapy and/or need for surgery.

RESULTS:

After the induction regimen, 29 patients (80.6%) achieved clinical remission, and serum CRP values returned to normal in 20 patients (55.6%). In the IUS at 12 weeks, treatment induced a statistically significant reduction in the wall thickness (p < 0.001) and color Doppler grade (p < 0.001), as well as resolution of complications in 66.7% of patients (p < 0.03). IUS after 1 year of biological therapy showed TH in 14/33 patients (42.4%). During the follow-up (median 48.5 months), 23 of the 33 (69.7%) patients in remission or response after induction therapy presented a good outcome. Sonographic TH was significantly related with better outcomes, with only 1/14 patients having a poor outcome compared to 9/19 without TH (OR 11.7, 95% CI 1.2-108.2 p = 0.01, Chi-squared test).

CONCLUSION:

Patients who achieve TH on IUS with biological treatment have better clinical outcomes.

• Authors: José María Paredes, Nadia Moreno, Patricia Latorre, Tomás Ripollés, María Jesús Martinez, José Vizuete, Eduardo Moreno-Osset
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 64 Issue 9 Pg. 2600-2606 (09 2019) ISSN: 1573-2568 [Electronic] United States
• PMID: 30874986 (Publication Type: Journal Article)

Chemical References

• Gastrointestinal Agents
• Tumor Necrosis Factor-alpha
• C-Reactive Protein
• Infliximab
• Adalimumab

Topics

• Adalimumab (therapeutic use)
• Adult
• Aged
• C-Reactive Protein (metabolism)
• Crohn Disease (blood, diagnostic imaging, drug therapy)
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Infliximab (therapeutic use)
• Male
• Middle Aged
• Prospective Studies
• Severity of Illness Index
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Ultrasonography, Doppler, Color
• Wound Healing
• Young Adult