Publication:
Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease.

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Date

2020-07-28

Authors

Rodriguez-Lago, Iago
Hoyo, Javier Del
Perez-Girbes, Alexandre
Garrido-Marin, Alejandro
Casanova, Maria Jose
Chaparro, María
Fernandez-Clotet, Agnes
Castro-Poceiro, Jesus
García, Maria Jose
Sanchez, Sara

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John Wiley & Sons
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There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn's disease. The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn's disease complicated with symptomatic strictures. 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. 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. 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.

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MeSH Terms

Adalimumab
Adult
Age factors
Biological factors
Constriction, pathologic
Crohn disease
Endoscopy, gastrointestinal
Female
Follow-up studies
Humans
Infliximab
Intestines
Male
Middle aged
Patient admission
Postoperative complications
Retrospective studies
Risk factors
Time-to-treatment
Treatment outcome
Tumor necrosis factor-alpha
Young adult

DeCS Terms

Admision del paciente
Complicaciones posoperatorias
Constriccion patologica
Endoscopía gastrointestinal
Enfermedad de Crohn
Factor de cecrosis tumoral alfa
Resultado del tratamiento

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Keywords

Anti-TNF, Crohn’s disease, biologic drug, stricture, surgery

Citation

Rodríguez-Lago I, Hoyo JD, Pérez-Girbés A, Garrido-Marín A, Casanova MJ, Chaparro M, et al. Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease. United European Gastroenterol J. 2020 Nov;8(9):1056-1066