Magnetic resonance enterography findings as predictors of clinical outcome following antitumor necrosis factor treatment in small bowel Crohn's disease. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Gibson, David J.; Murphy, David J.; Smyth, Anna E.; McEvoy, Sinead H.; Keegan, Denise; Byrne, Kathryn; Mulcahy, Hugh E.; Cullen, Garret; Malone, Dermot E.; Doherty, Glen A.
• Is Part Of: European journal of gastroenterology & hepatology. Volume 27:Issue 8(2015:Aug.)
• Publication Date: 2015-08
• Subjects: antitumor necrosis factor -- Crohn's -- magnetic resonance enterography -- surgery; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000399
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Aims: To determine whether specific magnetic resonance enterography (MRE) findings can predict outcome following commencement of antitumor necrosis factor (aTNF) in small bowel Crohn's disease (CD) Patients and methods: This was a single-centre retrospective study of patients with CD who commenced aTNF (infliximab or adalimumab) between 2007 and 2013. Patients who had an MRE within 6 months before commencing aTNF were included. The primary end-point was the need for CD-related surgery. The secondary end-points were time to surgery and time to treatment failure. The relationship between these end-points, clinical variables and specific MRE findings were studied. Results: Four hundred and eighteen patients commenced aTNF for CD during the study period. Seventy-five patients had an MRE within 6 months before commencing aTNF (30 infliximab; 45 adalimumab). The median time from MRE to commencing aTNF was 43 days (IQR 19.5–87 days). Eighteen of 75 (24%) had surgery during a median follow-up of 16.7 months (IQR 9.0–30.1 months). Patients with small bowel stenosis (SBS) on MRE were at a significantly higher risk of requiring surgery: 12/18 (66.7%) versus 6/57 (10.5%) ( P <0.001). Time to surgery was significantly shorter in patients with SBS on MRE ( P <0.001). In a multivariate analysis, SBS ( P <0.0001, hazard ratio 26.45, 95% confidence interval 5.45–128.49) and presence of penetrating complications ( P =0.003, hazard ratio 36.53, 95% confidence interval 3.40–393.19) were associated independently with time to surgery. Conclusion: SBS and penetrating complications on MRE are associated independently with a need for early surgery and treatment failure in patients commencing aTNF.