Early Ultrasound Response and Progressive Transmural Remission After Treatment With Ustekinumab in Crohn’s Disease

Kucharzik, Torsten; Wilkens, Rune; D’Agostino, Maria-Antonietta; Maconi, Giovanni; Bars, Manuela Le; Lahaye, Marjolein; Bravatá, Ivana; Nazar, Maciej; Ni, Lioudmila; Ercole, E.; Allocca, Mariangela; Machková, Naděžda; Voogd, Floris Ae de; Palmela, Carolina; Vaughan, Rose

doi:10.1016/j.cgh.2022.05.055

Cited by 31 publications

(25 citation statements)

References 28 publications

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“…A previous study (STARDUST trial) reported that patients with CD treated with UST achieved progressive transmural remission from week 4 to 48 (24.1% at week 48). 13 , 30 Another real-world clinical study (SUCCESS trial) showed that 30% of patients with CD achieved radiographic remission at 12 months after UST treatment. 14 In our study, only 18.9% patients achieved TH at W26 of UST therapy.…”

Section: Discussionmentioning

confidence: 99%

“… 11 , 12 In patients with CD receiving 1-year UST treatment, the cumulative rates of clinical remission (CR) and MH were both nearly 40%. 13 , 14 Serum UST concentrations are associated with outcomes in patients with CD. 15 However, early TH has rarely been assessed using MRE, and risk factors associated with TH in UST therapy remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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Early transmural healing and its predictors assessed by magnetic resonance enterography in patients with Crohn’s disease receiving ustekinumab

Zhou

Zhang

et al. 2023

Therap Adv Gastroenterol

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Background: Transmural healing (TH) is a potential therapeutic goal of Crohn’s disease (CD) and is associated with better clinical outcomes. However, few studies have described early TH and its predictors. Objectives: We aimed to evaluate early TH and its predictors using magnetic resonance enterography (MRE) in patients with CD receiving ustekinumab (UST). Design: This was a retrospective observational study. Methods: Patients with active CD treated with UST and their intestinal segments with bowel wall thickness (BWT) ⩽ 3 mm at baseline were included. Clinical characteristics, laboratory indicators, endoscopic manifestations, and MRE indices were evaluated at baseline and week 26 (W26) of the therapy. The following MRE parameters were assessed: BWT, edema, apparent diffusion coefficient (ADC), Clermont score, Magnetic Resonance Index of Activity score, fat stranding, comb sign, and stricture. TH was defined as BWT ⩽ 3 mm without any signs of inflammation (i.e., ulceration, edema, diffusion-weighted hyperintensity, and increased contrast enhancement) at W26. Results: The study included 37 patients with 106 intestinal segments (including 15 proximal small intestines, 33 terminal ilea, and 58 colons). Clinical features, laboratory indicators, endoscopic results, and MRE parameters at W26 were significantly improved after UST treatment in both patient-based and intestinal segment-based analysis. Seven (18.9%) patients and 26 (24.5%) intestinal segments achieved TH at W26. Baseline BWT [odds ratio (OR) = 0.287, 95% confidence interval (CI), 0.090–0.918, p = 0.035] and ADC (OR = 2.997, 95% CI, 1.009–8.908, p = 0.048) predict TH of patients at W26. Baseline ADC (OR = 2.857, 95% CI, 1.285–6.349, p = 0.010) and presence of stenosis (OR = 0.196, 95% CI, 0.052–0.735, p = 0.016) were associated with TH of segments at W26. Conclusion: Early TH assessed by MRE was observed in nearly one-fifth of patients with CD and intestinal segments after UST treatment for 26 weeks. Baseline MRE indices such as BWT and presence of stenosis might negatively predict TH, while ADC might positively predict early TH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early transmural healing and its predictors assessed by magnetic resonance enterography in patients with Crohn’s disease receiving ustekinumab

Zhou

Zhang

et al. 2023

Therap Adv Gastroenterol

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“…TH, defined as a BWT ≤ 3 mm and absent hyperemia by CDS, has been shown to be achievable in approximately 25%-31% of adult patients with CD after 2 years of treatment[ 28 - 32 ]. The STARDUST sub-study recently evaluated the effect of ustekinumab on TH monitored by IUS and demonstrated increasing TH rates to a total of 24.1% by week 48[ 33 ]. In 40 adult patients with endoscopically active CD initiating anti-tumor necrosis factor therapy, an 18% decrease in BWT 4-8 wk post-induction predicted endoscopic response [area under the receiver operating characteristic curve (AUROC) =0.77, odds ratio (OR) = 10.80, P = 0.012] and a BWT cut-off of 3.2 mm was accurate to detect endoscopic remission (AUROC = 0.94, OR = 39.42, P < 0.0001) at weeks 12-32[ 34 ].…”

Section: Monitoring Disease Activity and Treatment Responsementioning

confidence: 99%

Intestinal ultrasound as a non-invasive tool to monitor inflammatory bowel disease activity and guide clinical decision making

Dolinger¹,

Kayal²

2023

World J Gastroenterol

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Intestinal ultrasound (IUS) is a non-invasive, real-time, cross-sectional imaging tool that can be used at the point-of-care to assess disease activity in patients with Crohn’s disease or ulcerative colitis. IUS promotes quick and impactful treatment decisions that can modify disease progression and enhance patient compliance. This review will summarize the technical aspects of IUS, the evidence to support the use of IUS in disease activity monitoring, the comparison of IUS to current standard of care monitoring modalities such as colonoscopy and calprotectin, and the optimal positioning of IUS in a tight-control monitoring strategy.

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“…In a recent trial performed in CD patients treated with ustekinumab, an improvement of B-mode IUS variables was demonstrated after only 4 weeks of therapy with a progressive normalization through week 48 [ 18 ]. A quarter of the patients enrolled (24.1%) reached a TH after 48 weeks of treatment, and B-mode IUS parameters after 4 weeks were able to predict the endoscopic response at week 48 (negative predictive value 73%)…”

Section: Standard Intestinal Ultrasound and Color Dopplermentioning

confidence: 99%

Role of Multiparametric Intestinal Ultrasound in the Evaluation of Response to Biologic Therapy in Adults with Crohn’s Disease

et al. 2022

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Crohn’s disease is one of the two most common types of inflammatory bowel disease. Current medical therapies are based on the use of glucocorticoids, exclusive enteral nutrition, immunosuppressors such as azathioprine and methotrexate, and biological agents such as infliximab, adalimumab, vedolizumab, or ustekinumab. International guidelines suggest regular disease assessment and surveillance through objective instruments to adjust and personalize the therapy, reducing the overall rates of hospitalization and surgery. Although endoscopy represents the gold-standard for surveillance, its frequent use is strongly bordered by associated risks and costs. Consequently, alternative non-invasive tools to objectify disease activity and rule active inflammation out are emerging. Alongside laboratory exams and computed tomography or magnetic resonance enterography, intestinal ultrasonography (IUS) shows to be a valid choice to assess transmural inflammation and to detect transmural healing, defined as bowel wall thickness normalization, no hypervascularization, normal stratification, and no creeping fat. Compared to magnetic resonance imaging (MRI) or computed tomography, CT scan, IUS is cheaper and more widespread, with very similar accuracy. Furthermore, share wave elastography, color Doppler, and contrast-enhanced ultrasonography (CEUS) succeed in amplifying the capacity to determine the disease location, disease activity, and complications. This review aimed to discuss the role of standard and novel ultrasound techniques such as CEUS, SICUS, or share wave elastography in adults with Crohn’s disease, mainly for therapeutic monitoring and follow-up.

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Early Ultrasound Response and Progressive Transmural Remission After Treatment With Ustekinumab in Crohn’s Disease

Cited by 31 publications

References 28 publications

Early transmural healing and its predictors assessed by magnetic resonance enterography in patients with Crohn’s disease receiving ustekinumab

Early transmural healing and its predictors assessed by magnetic resonance enterography in patients with Crohn’s disease receiving ustekinumab

Intestinal ultrasound as a non-invasive tool to monitor inflammatory bowel disease activity and guide clinical decision making

Role of Multiparametric Intestinal Ultrasound in the Evaluation of Response to Biologic Therapy in Adults with Crohn’s Disease

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