Cross-sectional evaluation of transmural healing in Crohn’s disease: Mural and mesenteric parameters — Authors’ reply

Castiglione, Fabiana; Testa, Anna; Imperatore, Nicola; Rispo, Antonio

doi:10.1016/j.dld.2017.11.014

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…For this reason, transmural Healing – which is defined as the normalisation of bowel wall thickness (BWT) of all inflamed segments involved in CD – has been recently proposed as a new endpoint for CD treatment. Recent studies have demonstrated that transmural healing could be a promising treatment goal achievable in about a quarter of CD patients treated with anti‐tumour necrosis factor (TNF) alpha (infliximab and adalimumab) …”

Section: Introductionmentioning

confidence: 99%

One‐year clinical outcomes with biologics in Crohn's disease: transmural healing compared with mucosal or no healing

Castiglione

Imperatore

Testa

et al. 2019

Aliment Pharmacol Ther

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127

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Background: While mucosal healing has been proved to predict relevant clinical outcomes in Crohn's disease (CD), little is known about the long-term significance of transmural healing. Aims:To prospectively assess the 1-year clinical outcomes in CD patients achieving transmural healing following treatment with biologics, and to compare them with those in patients reaching only mucosal healing or no healing.Methods: Observational longitudinal study, evaluating 1-year outcomes in terms of steroid-free clinical remission, rate of hospitalisation and need for surgery in a group of CD patients treated with anti-tumour necrosis factor (TNF) alpha for 2 years.Bowel sonography was used in all patients to determine transmural healing.Results: Of 218 patients who completed a 2-year treatment course with anti-TNF alpha, 68 (31.2%) presented transmural (plus mucosal) healing (bowel wall thickness ≤3 mm at bowel sonography), 60 (27.5%) mucosal healing only, and 90 (41.3%) did not achieve any intestinal healing. Transmural healing was associated with a higher rate of steroid-free clinical remission (95.6%), lower rates of hospitalisation (8.8%) and need for surgery (0%) at 1 year compared to mucosal (75%, 28.3% and 10%, respectively) and no healing (41%, 66.6% and 35.5%, respectively) (P < 0.001). Furthermore, transmural healing was associated with longer intervals until clinical relapse (HR, hazard ratio 0.87, P = 0.01), hospitalisation (HR 0.88, P = 0.002) and surgery (HR 0.94, P = 0.008) than mucosal healing. Also among patients discontinuing treatment with biologics, transmural healing predicted better clinical outcomes at 1 year than mucosal healing (P = 0.01). Conclusions:Transmural healing is an ambitious and powerful treatment goal associated, to a greater extent than mucosal healing, with improvement of all clinical outcomes. Additionally, transmural healing is associated with better long-term clinical outcomes than mucosal healing also after discontinuation of biologics.

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Section: Introductionmentioning

confidence: 99%

One‐year clinical outcomes with biologics in Crohn's disease: transmural healing compared with mucosal or no healing

Castiglione

Imperatore

Testa

et al. 2019

Aliment Pharmacol Ther

Self Cite

127

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“… 6 , 12 We defined transmural healing as a normal bowel wall thickness with the normalization of stratification and no hypervascularization using cross-sectional imaging studies. 13 …”

Section: Methodsmentioning

confidence: 99%

Effectiveness and tolerability of methotrexate monotherapy in Crohn’s disease patients: a multicenter observational study

Park,

Chun,

Park

et al. 2023

Therap Adv Gastroenterol

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Background: Methotrexate monotherapy is recommended as a maintenance therapy for Crohn’s disease (CD). However, long-term follow-up data are scarce. Objectives: We aimed to examine the effectiveness and tolerability of methotrexate monotherapy in 94 CD patients from three inflammatory bowel disease Clinics in Korea. Design: This was a multicenter retrospective observational study. Methods: Patients with active CD treated with methotrexate monotherapy were included. Clinical characteristics, laboratory indicators, endoscopy indices were evaluated at baseline, 6, 12, and 24 months. Independent factors associated with long-term clinical and endoscopic outcomes were determined. Results: Methotrexate was administered orally (70.2%) or parenterally (29.8%). The mean methotrexate induction dose was 15.3 ± 0.4 mg/week, and the mean duration of therapy was 26.2 months. Of 76 patients who were treated for >6 months, the clinical remission rates were 76.3%, 74.6%, and 80.0% at 6, 12, and 24 months, respectively, by per-protocol analysis. The mean CRP levels were 7.5 ± 1.3, 5.3 ± 1.2, 3.8 ± 0.7, and 2.6 ± 0.5 mg/L at 0, 6, 12, and 24 months, respectively. Of 31 patients who underwent follow-up endoscopy after 27.5 months, the endoscopic remission rate was 38.7%. Baseline hemoglobin level <10 g/dL was a significant independent factor negatively associated with clinical remission at 6 [odds ratio (OR): 0.023, 95% confidence interval (CI): 0.003–0.206, p = 0.001] and 12 (OR: 0.079, 95% CI: 0.009–0.699, p = 0.023) months. Parenteral administration was a significant independent factor positively associated with clinical remission (OR: 11.231, 95% CI: 1.027–122.811, p = 0.047) and endoscopic remission (hazard ratio: 4.711, 95% CI: 1.398–15.874, p = 0.012) at 12 months. Conclusions: Methotrexate monotherapy was effective and tolerable as a maintenance therapy in CD patients.

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

et al. 2019

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Cross-sectional evaluation of transmural healing in Crohn’s disease: Mural and mesenteric parameters — Authors’ reply

Cited by 3 publications

References 6 publications

One‐year clinical outcomes with biologics in Crohn's disease: transmural healing compared with mucosal or no healing

One‐year clinical outcomes with biologics in Crohn's disease: transmural healing compared with mucosal or no healing

Effectiveness and tolerability of methotrexate monotherapy in Crohn’s disease patients: a multicenter observational study

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

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