Intestinal healing after anti-TNF induction therapy predicts long-term response to one-year treatment in patients with ileocolonic Crohn’s disease naive to anti-TNF agents

Abstract

IntroductionObjective assessment of Crohn’s disease (CD) activity in patients treated with anti-tumour necrosis factor (anti-TNF) antibodies is crucial for the prediction of its long-term results. Mucosal healing estimated endoscopically has a strong predictive value; however, only combined assessment together with transmural healing in magnetic resonance enterography (MRE) gives full information about the whole spectrum of inflammatory lesions in CD.AimTo assess the usefulness of intestinal healing phenomenon in CD, defined as improvement both in endoscopy and MRE, after anti-TNF induction therapy, in predicting long-term results of 1-year treatment.Material and methodsTwenty-six patients with ileocolonic CD were enrolled into the study. In this group a parallel assessment of disease activity was estimated before and after induction doses of anti-TNF antibodies with ileocolonoscopy and MRE by using appropriate scores. Subsequently the patients were treated until 12 months and then followed-up. The associations between intestinal healing (assessed in MRE and endoscopy), and mucosal and transmural healing with long-term results of 1-year anti-TNF therapy were analysed statistically.ResultsThe median time of follow-up was 29 months (interquartile range – IQR: 14–46). Intestinal healing was significantly associated with favourable therapeutic outcomes (p = 0.02) and had 75% (IQR: 35–97%) sensitivity and 72% (IQR: 46–90%) specificity in predicting long-term remission. Other parameters were not useful (transmural healing) or their usefulness was of borderline significance (mucosal healing).ConclusionsDynamic assessment of intestinal healing is an accurate method in predicting long-term outcomes in CD patients responding to 1-year anti-TNF therapy.

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

“…Ripollés et al found that sonographic response after 12 and 52 weeks of treatment with biologics was predictive of good long‐term clinical outcomes. Eder et al demonstrated that the absence of transmural healing was associated with an almost 90% probability of exacerbation shortly after discontinuation of the anti‐TNF agent.…”

Treat-to-target in Crohn’s disease: Will transmural healing become a therapeutic endpoint?

“…The main characteristics of these studies are detailed in Table 1 [ 13 - 15 , 41 - 44 ]. Three studies were prospective[ 15 , 41 , 44 ] and four were retrospective[ 13 , 14 , 42 , 43 ]. Only one study was performed in children[ 43 ].…”

“…Only one study was performed in children[ 43 ]. The size of the study population ranged from 26[ 42 ] to 214[ 13 ] patients. Location of CD, defined by Montreal[ 45 ] or Paris[ 46 ] classification was as follows: ileocolon (L3)[ 42 ]; terminal ileum (± caecum) (L1) and ileocolon (L3)[ 13 , 14 , 44 ]; and, all types of location (L1, L2, L3 ± L4)[ 15 , 41 , 43 ].…”

“…The size of the study population ranged from 26[ 42 ] to 214[ 13 ] patients. Location of CD, defined by Montreal[ 45 ] or Paris[ 46 ] classification was as follows: ileocolon (L3)[ 42 ]; terminal ileum (± caecum) (L1) and ileocolon (L3)[ 13 , 14 , 44 ]; and, all types of location (L1, L2, L3 ± L4)[ 15 , 41 , 43 ]. Patients presented all types of CD behavior (defined by Montreal[ 45 ] or Paris[ 46 ] classification), the most prominent being inflammatory behavior (B1)[ 13 , 14 , 41 - 44 ].…”

“…Prior CD-related surgery was mentioned in five studies[ 13 - 15 , 41 , 44 ] and its rate ranged from 22.8%[ 15 ] to 61.3%[ 14 ]. All studies mentioned the duration of the disease, with the lowest median being 4 year[ 42 ] and the highest median being 9 year[ 14 ]. Three studies included only patients treated with anti-TNF agents, either as monotherapy or combined with other medication[ 41 , 42 , 44 ], while in other studies patients were on various therapies[ 13 - 15 , 43 ].…”