Response Assessed by Ultrasonography as Target of Biological Treatment for Crohn’s Disease

Zorzi, Francesca; Ghosh, Subrata; Chiaramonte, Carlo; Lolli, Elisabetta; Ventura, Martina; Onali, S.; Cristofaro, Elena De; Fantini, Massimo; Biancone, Livia; Monteleone, Giovanni; Calabrese, Emma

doi:10.1016/j.cgh.2019.10.042

Cited by 41 publications

(49 citation statements)

References 35 publications

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“…13 Different studies have demonstrated that TH could be a robust but puzzling endpoint that can be achieved in about one-fourth of patients treated with anti-TNF agents. 2,14,15 Furthermore, Zorzi et al 5 demonstrated that ultrasonographic response is noted in more than 50% of patients after 1 year of anti-TNF therapy, and this response is associated with significantly reduced long-term risk of corticosteroid need, hospitalizations, and/or surgeries among patients with CD. The increasing use of BUS in CD has introduced new challenges, including how to define TH, partial ultrasonographic remission, and how to interpret discrepancies between endoscopic healing and persistence of transmural abnormalities in BUS assessments.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were examined in the fasting state. The US examinations were performed by the gastroenterologists managing and treating the patient with different US devices using convex probe (1-8 MHz) and a high-frequency, linear-array transducer (3)(4)(5)(6)(7)(8)(9)(10)(11). Examiners were all experienced bowel sonographers and were not blinded to clinical/ biochemical parameters of the patient.…”

Section: Bowel Ultrasonographymentioning

confidence: 99%

“…Castiglione et al 4 showed that normalization of the parietal thickening assessed by BUS was associated with a higher rate of steroid-free clinical remission and a lower rate of relapse at 1 year compared with mucosal healing and no healing. Zorzi et al 5 demonstrated that ultrasonographic response is noted in more than 50% of patients after 1 year of anti-tumor necrosis factor (TNF) therapy, and this response is associated with significantly reduced long-term risk of corticosteroid need, hospitalizations, and/or surgeries among patients with CD. Monitoring CD patients with an ultrasonographic tight control during biological therapies could be a valuable method to assess lesion remodeling or healing and a decision instrument to continue or change therapies.…”

mentioning

confidence: 99%

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Ultrasonography Tight Control and Monitoring in Crohn’s Disease During Different Biological Therapies: A Multicenter Study

Calabrese

Rispo

Zorzi

et al. 2022

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS:Bowel ultrasonography (BUS) is a noninvasive tool for evaluating bowel activity in Crohn's disease (CD) patients. Aim of our multicenter study was to assess whether BUS helps to monitor intestinal activity improvement/resolution following different biological therapies. METHODS:Adult CD patients were prospectively enrolled at 16 sites in Italy. Changes in BUS parameters [i.e. bowel wall thickening (BWT), lesion length, echo pattern, blood flow changes and transmural healing (TH: normalization of all BUS parameters)] were analyzed at baseline and after 3, 6 and 12 months of different biological therapies. RESULTS:One hundred eighty-eight out of 201 CD patients were enrolled and analyzed (116 males [62%]; median age 36 years). Fifty-five percent of patients were treated with adalimumab, 16% with infliximab, 13% with vedolizumab and 16% with ustekinumab. TH rates at 12 months were 27.5% with an NNT of 3.6. TH at 12 months after adalimumab was 26.8%, 37% after infliximab, 27.2% after vedolizumab and 20% after ustekinumab. Mean BWT improvement from baseline was statistically significant at 3 and 12 months (P < .0001). Median Harvey-Bradshaw index, C-reactive protein and fecal calprotectin decreased after 12 months from baseline (P < .0001). Logistic regression analysis showed colonic lesion was associated with a higher risk of TH at 3 months and a greater BWT at baseline was associated with a lower risk of TH at 3 months [P [ .03 (OR 0.70, 95% CI 0.50-0.97)] and 12 months [P [ .01 (OR 0.58, 95% CI 0.38-0.89)]. At 3 months therapy optimization during the study was the only independent factor associated with a higher risk of no ultrasonographic response [P [ .02 (OR 3.34, 95% CI 1.18-9.47)] and at 12 months disease duration [P [ .02 (OR 3.03, 95% CI 1.15-7.94)]. CONCLUSIONS:Data indicate that BUS is useful to monitor biologics-induced bowel activity improvement/ resolution in CD.

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Section: Discussionmentioning

confidence: 99%

Section: Bowel Ultrasonographymentioning

confidence: 99%

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confidence: 99%

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Ultrasonography Tight Control and Monitoring in Crohn’s Disease During Different Biological Therapies: A Multicenter Study

Calabrese

Rispo

Zorzi

et al. 2022

Clinical Gastroenterology and Hepatology

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“… 26 Recent studies have shown the benefits of attaining TH in long-term outcomes, although the definition of TH varies. 27 , 28 Deepak et al . 22 and Zorzi et al .…”

Section: Discussionmentioning

confidence: 99%

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn’s disease

Zhuang

et al. 2021

Therap Adv Gastroenterol

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Background: Transmural healing (TH) is being increasingly recognized for reflecting deep remission in Crohn’s disease (CD). The long-term clinical significance of achieving TH is still not fully known. We aimed to evaluate TH as a predictor of long-term positive outcomes using intestinal ultrasonography (US), with comparison with the established endpoint mucosal healing (MH). Methods: CD patients were consecutively recruited from September 2015 to August 2018 at a single tertiary hospital. All patients were evaluated at baseline and followed up at 6 months prospectively with a guideline-based treatment regimen. Achieving TH/MH or not was evaluated by US/colonoscopy at the first follow-up. Long-term outcomes including steroid-free clinical remission (CR), drug escalation, hospitalization, and surgery, were recorded after at least another 12 months. Results: We identified 77 patients with a median age of 30 years (range, 12–73 years). Twenty-five (32%) patients achieved TH, and 31 (40%) patients achieved MH. TH and MH were poorly correlated (Cohen’s κ = 0.387; p < 0.05). Univariate analysis showed that both MH and TH were associated with better long-term outcomes. In multivariate analysis, TH was an independent predictor of steroid-free CR [odds ratio (OR), 52.6; p < 0.001], drug escalation (OR, 0.1; p = 0.002), and hospitalization (OR, 0.05; p = 0.005), while MH was an independent predictor of drug escalation (OR, 0.3; p = 0.05). Smoking habit was the only predictor of surgery (OR, 6.6; p = 0.02). Conclusion: TH is an independent predictor of more favorable long-term outcomes than MH, suggesting that TH could become the potential treatment endpoint in CD. Plain language summary Transmural healing predicts good prognosis in Crohn’s disease The therapeutic endpoints of Crohn’s disease keep evolving. The long-term clinical significance of achieving transmural healing is not fully discovered. Transmural healing is an independent predictor of more favorable long-term outcomes than mucosal healing. Transmural healing could become the potential treatment endpoint in Crohn’s disease.

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“…According to this small prospective study, a significant improvement of SLIC was observed after the induction period. Moreover, SICUS-responders to anti-TNFα agents have shown a better long-term outcome in terms of need for surgery, hospitalization rate and use for steroids (Zorzi et al, 2020).…”

Section: Small Intestine Contrast Ultrasonography (Sicus)mentioning

confidence: 99%

Ultrasonographic Evaluation of Intestinal Fibrosis and Inflammation in Crohn’s Disease. The State of the Art

et al. 2021

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The evaluation of the degree of inflammation and fibrosis, intrinsic elements in intestinal wall damage of Crohn’s disease, is essential to individuate the extent of the lesions and the presence of strictures. This information will contribute to the choice of the appropriate therapeutic approach, the prediction of the response to therapy and the course of the disease. The accurate evaluation of the extent and severity of inflammation and/or fibrosis in Crohn’s disease currently requires histopathological analysis of the intestinal wall. However, in clinical practice and research, transmural assessment of the intestinal wall with cross sectional imaging is increasingly used for this purpose. The B-mode ultrasonograhic characteristics of the intestinal wall, the assessment of its vascularization by color Doppler and I.V. contrast agents, and the evaluation of the mechanical and elastic properties by sonoelastography, may provide useful and accurate information on the severity and extent of inflammation and intestinal fibrosis in Crohn’s disease. The purpose of this review is to provide an update on current sonographic methods to discriminate inflammation and fibrosis in Crohn’s disease.

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Response Assessed by Ultrasonography as Target of Biological Treatment for Crohn’s Disease

Cited by 41 publications

References 35 publications

Ultrasonography Tight Control and Monitoring in Crohn’s Disease During Different Biological Therapies: A Multicenter Study

Ultrasonography Tight Control and Monitoring in Crohn’s Disease During Different Biological Therapies: A Multicenter Study

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn’s disease

Ultrasonographic Evaluation of Intestinal Fibrosis and Inflammation in Crohn’s Disease. The State of the Art

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