Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease.

Abstract

BACKGROUND:

There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn's disease.

AIM:

The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn's disease complicated with symptomatic strictures.

METHODS:

In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn's disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up.

RESULTS:

Overall, 262 patients with Crohn's disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab (N = 141, 54%) or adalimumab (N = 121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19-85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn's disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18-2.22; and HR 1.55, 95% CI 1.1-2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness.

CONCLUSIONS:

Anti-TNF agents are effective in approximately a quarter of patients with Crohn's disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting.

• Authors: Iago Rodríguez-Lago, Javier Del Hoyo, Alexandre Pérez-Girbés, Alejandro Garrido-Marín, María José Casanova, María Chaparro, Agnès Fernández-Clotet, Jesús Castro-Poceiro, María José García, Sara Sánchez, Rocío Ferreiro-Iglesias, Iria Bastón, Marta Piqueras, Lola Esteba I Bech de Careda, Raquel Mena, Cristina Suárez, Joaquín Poza Cordón, Alicia López-García, Lucía Márquez, Maite Arroyo, Erika Alfambra, Mónica Sierra, Noelia Cano, Pedro Delgado-Guillena, Víctor Morales-Alvarado, Juan Carlos Aparicio, Iván Guerra, Carolina Aulló, Olga Merino, Laura Arranz, María Araceli Hidalgo, Jordina Llaó, Rocío Plaza, Gema Molina, Paola Torres, Pablo Pérez-Galindo, María Giselle Romero, Claudia Herrera-deGuise, Edisa Armesto, Francisco Mesonero, Santiago Frago-Larramona, José Manuel Benítez, Marta Calvo, María Del Carmen López Martín, Ainara Elorza, Alejandro Larena, Elena Peña, María Del Carmen Rodríguez-Grau, Jaime de Miguel-Criado, Belén Botella, José Antonio Olmos, Laura López, Urko Aguirre, Javier P Gisbert, Young GETECCU Group
• Journal: United European gastroenterology journal (United European Gastroenterol J) Vol. 8 Issue 9 Pg. 1056-1066 (11 2020) ISSN: 2050-6414 [Electronic] England
• PMID: 32723069 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biological Factors
• TNF protein, human
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab

Topics

• Adalimumab (pharmacology, therapeutic use)
• Adult
• Age Factors
• Biological Factors (pharmacology, therapeutic use)
• Constriction, Pathologic (diagnosis, immunology, therapy)
• Crohn Disease (complications, diagnosis, immunology, therapy)
• Endoscopy, Gastrointestinal (adverse effects, statistics & numerical data)
• Female
• Follow-Up Studies
• Humans
• Infliximab (pharmacology, therapeutic use)
• Intestines (drug effects, immunology, surgery)
• Male
• Middle Aged
• Patient Admission (statistics & numerical data)
• Postoperative Complications (epidemiology, etiology)
• Retrospective Studies
• Risk Factors
• Time-to-Treatment
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Young Adult