Endoscopic response to tumor necrosis factor inhibitors predicts long term benefits in Crohn’s disease
| Autor: | Azucena Salas, Alejandro Vara, A. Giner, R. Barastegui, Marta Gallego, Elena Ricart, Ingrid Ordás, Ignacio Alfaro, Julián Panés, Alicia López-García, Maria Carme Masamunt, Jesús Castro, Núria Planell |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Crohn’s disease
Male Time Factors Disease Single Center Severity of Illness Index Gastroenterology 0302 clinical medicine Crohn Disease Prospective Studies Intestinal Mucosa Crohn's disease medicine.diagnostic_test Mucosal healing Area under the curve Colonoscopy General Medicine Middle Aged Prognosis Treatment Outcome 030220 oncology & carcinogenesis Biomarker (medicine) Drug Therapy Combination Female 030211 gastroenterology & hepatology Tumor necrosis factor alpha Adult medicine.medical_specialty Tumor necrosis factor Colon Crohn’s Disease Endoscopic Index of Severity Young Adult 03 medical and health sciences Gastrointestinal Agents Ileum Predictive Value of Tests Internal medicine medicine Humans Aged Tumor Necrosis Factor-alpha business.industry Adalimumab Endoscopy medicine.disease Infliximab Prospective Study business |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 1007-9327 |
| DOI: | 10.3748/wjg.v25.i14.1764 |
| Popis: | BACKGROUND Identifying predictors of therapeutic response is the cornerstone of personalized medicine. AIM To identify predictors of long-term mucosal healing (MH) in patients with Crohn’s disease (CD) treated with tumor necrosis factor α (TNF-α) inhibitors. METHODS Prospective single center study. Consecutive patients with clinically active CD requiring treatment with a TNF-α inhibitor were included. A baseline segmental CD Endoscopic Index of Severity (CDEIS) ≥ 10 in at least one segment or the presence of ulcerations were required for inclusion. Clinical, biological and endoscopic data were obtained at baseline, weeks 14 and 46. Endoscopic response (ER) was defined as a decrease ≥ 50% from baseline CDEIS and MH as partial CDEIS ≤ 5 in all segments. RESULTS Of 62 patients were included. At baseline, median CD Activity Index and CDEIS were 201 and 6.7, respectively with a significant reduction after one year of treatment (53 and 3.0 respectively, P < 0.001). At week 14, 56% of patients achieved ER and 34% MH. At week 46, the corresponding percentages were 52% and 44%. Baseline disease characteristics or biomarkers did not predict MH. A decrease from baseline CDEIS at week 14 of at least 80% was the best predictor of MH at week 46 (59% sensitivity and 91% specificity; area under the curve = 0.778). CONCLUSION Clinical and biomarker data are not useful predictors of response to TNF-α inhibitors in CD, whereas ER to induction therapy, defined as 80% reduction in global CDEIS, is a robust predictor of long-term MH. Achievement of this endoscopic endpoint may be considered as a therapeutic target for anti-TNF-α therapy. |
| Databáze: | OpenAIRE |
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