Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease. Issue 9 (November 2020)

• Record Type: Journal Article
• Authors: Rodríguez-Lago, Iago; Hoyo, Javier Del; Pérez-Girbés, Alexandre; Garrido-Marín, Alejandro; Casanova, María José; Chaparro, María; Fernández-Clotet, Agnès; Castro-Poceiro, Jesús; García, María José; Sánchez, Sara; Ferreiro-Iglesias, Rocío; Bastón, Iria; Piqueras, Marta; Careda, Lola Esteba i Bech de; Mena, Raquel; Suárez, Cristina; Cordón, Joaquín Poza; López-García, Alicia; Márquez, Lucía; Arroyo, Maite; Alfambra, Erika; Sierra, Mónica; Cano, Noelia; Delgado-Guillena, Pedro; Morales-Alvarado, Víctor; Aparicio, Juan Carlos; Guerra, Iván; Aulló, Carolina; Merino, Olga; Arranz, Laura; Hidalgo, María Araceli; Llaó, Jordina; Plaza, Rocío; Molina, Gema; Torres, Paola; Pérez-Galindo, Pablo; Romero, María Giselle; Herrera-deGuise, Claudia; Armesto, Edisa; Mesonero, Francisco; Frago-Larramona, Santiago; Benítez, José Manuel; Calvo, Marta; Martín, María del Carmen López; Elorza, Ainara; Larena, Alejandro; Peña, Elena; Rodríguez-Grau, María del Carmen; Miguel-Criado, Jaime de; Botella, Belén; Olmos, José Antonio; López, Laura; Aguirre, Urko; Gisbert, Javier P.;
• Is Part Of: United European Gastroenterology journal. Volume 8:Issue 9(2020)
• Page Start: 1056
• Page End: 1066
• Publication Date: 2020-11
• Subjects: Anti-TNF -- biologic drug -- Crohn's disease -- stricture -- surgery; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640620947579
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn's disease. Aim: The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn's disease complicated with symptomatic strictures. Methods: In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn's disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up. Results: Overall, 262 patients with Crohn's disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab ( N = 141, 54%) or adalimumab ( N = 121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19–85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn's disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18–2.22; and HR 1.55, 95% CI 1.1–2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness. Conclusions: Anti-TNF agents are effective in approximately a quarter of patients with Crohn's disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting.