Early Transmural Response Assessed Using Magnetic Resonance Imaging Could Predict Sustained Clinical Remission and Prevent Bowel Damage in Patients with Crohn's Disease Treated with Anti-Tumour Necrosis Factor Therapy.

Abstract

BACKGROUND:

Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn's disease [CD].

AIMS:

We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage.

METHODS:

All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn's Disease Activity Index < 150, C-reactive protein < 5 mg/L and faecal calprotectin < 250 µg/g, with no switch of anti-TNF agents, no bowel resection and no therapeutic intensification between W12 and W52.

RESULTS:

Among 46 patients, 22 [47.8%] achieved CFREM at W52. Anti-TNF agents were able to heal almost all CD lesions as soon as W12 [p < 0.05]. Early transmural response defined as a 25% decrease of either Clermont score (odds ratio [OR] = 7.7 [1.7-34.0], p < 0.001) or Magnetic Resonance Index of Activity (OR = 4.2 [1.3-13.3], p = 0.015) was predictive of CFREM at W52. Achieving at least two items on W12-MRI among ulceration healing, disappearance of enlarged lymph nodes or sclerolipomatosis, ΔADC [apparent diffusion coefficient] > +10% or ΔRCE [relative contrast enhancement] > -30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0-0.9]; p = 0.037).

CONCLUSION:

Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD.

• Authors: L Messadeg, C Hordonneau, G Bouguen, F Goutorbe, J M Reimund, M Goutte, A L Boucher, J Scanzi, M Reymond, C Allimant, M Dapoigny, B Pereira, G Bommelaer, A Buisson
• Journal: Journal of Crohn's & colitis (J Crohns Colitis) Vol. 14 Issue 11 Pg. 1524-1534 (Nov 07 2020) ISSN: 1876-4479 [Electronic] England
• PMID: 32533769 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Biomarkers, Pharmacological
• Leukocyte L1 Antigen Complex
• Tumor Necrosis Factor Inhibitors
• C-Reactive Protein
• Infliximab
• Adalimumab

Topics

• Adalimumab (administration & dosage, adverse effects)
• Adult
• Biomarkers, Pharmacological (analysis)
• C-Reactive Protein (analysis)
• Crohn Disease (diagnosis, drug therapy, epidemiology, physiopathology)
• Feasibility Studies
• Female
• France (epidemiology)
• Humans
• Infliximab (administration & dosage, adverse effects)
• Intestinal Mucosa (diagnostic imaging, pathology)
• Leukocyte L1 Antigen Complex (analysis)
• Magnetic Resonance Imaging (methods)
• Male
• Predictive Value of Tests
• Prognosis
• Remission Induction (methods)
• Severity of Illness Index
• Tumor Necrosis Factor Inhibitors (administration & dosage, adverse effects)