Terminal Ileum Thickness During Maintenance Therapy Is a Predictive Marker of the Outcome of Infliximab Therapy in Crohn Disease.

Abstract

BACKGROUND:

Mucosal healing has been associated with long-term response to therapy for Crohn disease (CD). However, little is known about the significance of terminal ileum (TI) transmural thickness in predicting clinical outcomes.

METHODS:

In this retrospective observational cohort study, we examined the association of an index ultrasonographic assessment of TI thickness during the maintenance phase and the subsequent clinical outcome of CD in a cohort of patients treated with infliximab (IFX). Treatment failure was defined as treatment discontinuation because of lack of efficacy, a need for dose escalation, or surgery. Clinical response was defined as treatment continuation in the absence of any of the aforementioned failure criteria.

RESULTS:

Sixty patients with CD receiving IFX therapy were included in the study. The patients were followed for a median of 16 months (5-24 months) after an index intestinal ultrasound. Thirty-eight patients (63.3%) maintained response to the therapy and 22 patients (36.6%) failed the treatment, with a mean follow up of 10.5 months (6.5-17 months) vs 9.25 months (1-10.25 months), respectively. On univariate analysis, the only variables differing between treatment response and failure were a TI thickness of 2.8 vs 5 mm (P < 0.0001) and an IFX trough level of 6.6 vs 3.9 µg/mL (P = 0.008).On multivariable analysis, only a small bowel thickness of ≥4 mm was associated with the risk of treatment failure (odds ratio, 2.9; 95% CI, 1.49-5.55; P = 0.002).

CONCLUSIONS:

Our findings suggest that transmural thickness of ≥4 mm can predict subsequent treatment failure in patients with CD treated using IFX, indicating transmural thickness <4 mm as a potential novel valuable therapeutic target.

• Authors: Ahmad Albshesh, Bella Ungar, Shomron Ben-Horin, Rami Eliakim, Uri Kopylov, Dan Carter
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 26 Issue 10 Pg. 1619-1625 (09 18 2020) ISSN: 1536-4844 [Electronic] England
• PMID: 32860057 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2020 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Biomarkers
• Gastrointestinal Agents
• Infliximab

Topics

• Adult
• Biomarkers (analysis)
• Crohn Disease (drug therapy, pathology)
• Drug Monitoring (methods)
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Ileum (pathology)
• Infliximab (therapeutic use)
• Maintenance Chemotherapy
• Male
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Young Adult