Early sonographic response to a new medical therapy is associated with future treatment response or failure in patients with inflammatory bowel disease

Abstract

Objective Gastrointestinal ultrasound (GIUS) accurately assesses inflammation and is responsive to changes in inflammatory bowel disease. This study aimed to determine the prognostic utility of sonographic response in the first 14 weeks of a newly-instituted therapy with therapeutic response at 46 weeks and to compare its performance with standard clinical assessment tools. Methods Patients with sonographic evidence of inflammation were assessed by GIUS, clinical activity, serum C-reactive protein and faecal calprotectin again 2, 6 and 14 weeks after commencing a new biologic or thiopurine. Treatment failure was defined as undergoing surgery, hospitalisation, escalation of dosage or introduction of new medication over 46-weeks' follow-up. Sonographic response was defined as a decrease in bowel wall thickness and improved vascularity. Results In 31 patients (median age 49 years, 74% Crohn's disease), sonographic response at 14 weeks [OR 19.3, 95% confidence interval (CI), 3.23-101.10; P = 0.0054] and faecal calprotectin (P = 0.018), but no clinical disease activity or C-reactive protein, were predictive of subsequent treatment response. Sonographic response alone was predictive at week 6 (P = 0.016), but not week 2. 16% reduction in bowel wall thickness at 6 weeks (area-under-the-receiver-operator-curve=0.86; P = 0.002; sensitivity 72%, specificity 90%), with similar performance for 10% at 14 weeks, was associated with treatment response. Conclusion Sonographic response as early as 6 weeks after initiation of a new therapy may accurately predict treatment outcomes over 46 weeks and is superior to other markers used to monitor disease activity.

Intestinal barrier biomarkers in clinical evaluation of patients with inflammatory bowel disease

“…All patients undergoing biologic induction therapy, had sonographic bowel wall thickness >3 mm in the diseased bowel segment/s or faecal calprotectin ≥150 µg/g at baseline. Response to biologic induction therapy at ≥3 months was defined as sonographic bowel wall thickness decreasing by >0.5 mm and vascularity improvement by at least one grade [16], no vascularity detected on follow up ultrasound or faecal calprotectin reducing by >50% compared to baseline.…”

“…This study examined the utility of gastrointestinal ultrasound in assessing disease activity and treatment response. The protocol and patient recruitment have been published elsewhere [16]. Patients were recruited between July 2018 and January 2021.…”

Treat to target in Crohn’s disease: A practical guide for clinicians

“…This is exemplified by a lack of validated and consensus IUS disease activity scores, with a recent systematic review documenting the use of 21 ultrasound indices in 26 studies[ 81 ]. To date, bowel wall thickness represents the most studied and reliable measure of sonographic disease activity and has been shown to correlate well with future clinical and objective outcomes[ 75 , 76 , 82 , 83 ].…”