Effects of infliximab therapy on transmural lesions as assessed by magnetic resonance enteroclysis in patients with ileal Crohn's disease.

Abstract

BACKGROUND AND AIMS:

Anti TNF therapy induces mucosal healing in patients with Crohn's disease, but the effects on transmural inflammation in the ileum are not well understood. Magnetic resonance-enteroclysis (MRE) offers excellent imaging of transmural and peri-enteric lesions in Crohn's ileitis and we aimed to study its responsiveness to anti TNF therapy.

METHODS:

In this multi-center prospective trial, anti TNF naïve patients with ileal Crohn's disease and with increased CRP and contrast enhanced wall thickening received infliximab 5 mg/kg at weeks 0, 2 and 6, and q8 weeks maintenance MRE was performed at baseline, 2 weeks and 6 months and assessed based on a predefined MRE score of severity in ileal Crohn's Disease.

RESULTS:

Twenty patients were included; of those, 18 patients underwent MRE at week 2 and 15 patients at weeks 2 and 26 as scheduled. Inflammatory components of the MRE index decreased by ≥2 points and by ≥50% at week 26 (primary endpoint) in 40% and 32% of patients (per protocol and intention to treat analysis, respectively). The MRE index improved in 44% at week 2 and in 80% at week 26. Complete absence of inflammatory lesions was observed in 0/18 at week 2 and 13% (2/15) at week 26. The obstructive elements did not change. Clinical and CRP improvement occurred as early as wk 2, but only CDAI correlated with the MRE index.

CONCLUSION:

Improvement of MRE occurs from 2 weeks after infliximab therapy onwards and correlates with clinical response but normalization of MRE is rare.

• Authors: Gert Van Assche, Karin A Herrmann, Edouard Louis, Simon M Everett, Jean-Frédéric Colombel, Jean-François Rahier, Dirk Vanbeckevoort, Paul Meunier, Damian Tolan, Olivier Ernst, Paul Rutgeerts, Séverine Vermeire, Isolde Aerden, Alessandra Oortwijn, Thomas Ochsenkühn
• Journal: Journal of Crohn's & colitis (J Crohns Colitis) Vol. 7 Issue 12 Pg. 950-7 (Dec 2013) ISSN: 1876-4479 [Electronic] England
• PMID: 23411006 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Antibodies, Monoclonal
• Contrast Media
• C-Reactive Protein
• Gadolinium
• Infliximab

Topics

• Adult
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• C-Reactive Protein (metabolism)
• Contrast Media
• Crohn Disease (blood, drug therapy, pathology)
• Female
• Gadolinium
• Humans
• Ileitis (blood, drug therapy, pathology)
• Infliximab
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Severity of Illness Index
• Time Factors
• Young Adult