Iago Rodríguez-Lago1,2, Javier Del Hoyo3,4, Alexandre Pérez-Girbés5, Alejandro Garrido-Marín3, María José Casanova4,6,7, María Chaparro4,6,7, Agnès Fernández-Clotet4,8, Jesús Castro-Poceiro8, María José García9, Sara Sánchez10, Rocío Ferreiro-Iglesias11, Iria Bastón11, Marta Piqueras12, Lola Esteba I Bech de Careda13, Raquel Mena12, Cristina Suárez14, Joaquín Poza Cordón14, Alicia López-García15, Lucía Márquez15, Maite Arroyo4,16, Erika Alfambra4,16, Mónica Sierra17, Noelia Cano17, Pedro Delgado-Guillena18, Víctor Morales-Alvarado18, Juan Carlos Aparicio19, Iván Guerra20, Carolina Aulló21, Olga Merino22, Laura Arranz23, María Araceli Hidalgo24, Jordina Llaó25, Rocío Plaza26, Gema Molina27, Paola Torres28, Pablo Pérez-Galindo29, María Giselle Romero30, Claudia Herrera-deGuise31, Edisa Armesto32, Francisco Mesonero33, Santiago Frago-Larramona34, José Manuel Benítez35,36, Marta Calvo37, María Del Carmen López Martín38, Ainara Elorza1,2, Alejandro Larena39, Elena Peña40, María Del Carmen Rodríguez-Grau41, Jaime de Miguel-Criado42, Belén Botella43, José Antonio Olmos44, Laura López45, Urko Aguirre46, Javier P Gisbert4,6,7. 1. Hospital de Galdakao, Gastroenterology, Galdakao, Spain. 2. Biocruces Bizkaia Health Research Institute, Barakaldo, Spain. 3. Hospital Universitari i Politècnic de La Fe, Gastroenterology, Valencia, Spain. 4. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. 5. Hospital Universitari i Politècnic de La Fe (Valencia), Radiology, Valencia, Spain. 6. Hospital Universitario de La Princesa, Gastroenterology, Madrid, Spain. 7. Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain. 8. Hospital Clinic, Gastroenterology, Barcelona, Spain. 9. Hospital Universitario Marqués de Valdecilla, Gastroenterology, Santander, Spain. 10. Hospital Universitario Marqués de Valdecilla, Radiology, Santander, Spain. 11. Hospital Clínico Universitario de Santiago de Compostela, Gastroenterology, Santiago de Compostela, Spain. 12. Consorci Sanitari de Terrassa, Gastroenterology, Terrassa, Spain. 13. Consorci Sanitari de Terrassa, Radiology, Terrassa, Spain. 14. Hospital Universitario La Paz, Gastroenterology, Madrid, Spain. 15. Hospital del Mar, Gastroenterology, Barcelona, Spain, and Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. 16. IIS Aragón, Hospital Clínico Universitario Lozano Blesa, Gastroenterology, Zaragoza, Spain. 17. Complejo Asistencial Universitario de León, Gastroenterology, León, Spain. 18. Hospital General de Granollers, Gastroenterology, Granollers, Spain. 19. Hospital General de Granollers, Radiology, Granollers, Spain. 20. Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain, and Instituto de Investigación de La Paz (IdiPaz), Madrid, Spain. 21. Hospital Universitario de Fuenlabrada, Radiology, Fuenlabrada, Spain. 22. Hospital Universitario de Cruces, Gastroenterology, Barakaldo, Spain. 23. Hospital Ntra. Sra. Candelaria, Gastroenterology, Santa Cruz de Tenerife, Spain. 24. Hospital Ntra. Sra. Candelaria, Radiology, Santa Cruz de Tenerife, Spain. 25. Althaia, Xarxa Assistencial Universitària de Manresa, Gastroenterology, Manresa, Spain. 26. Hospital Universitario Infanta Leonor, Gastroenterology, Madrid, Spain. 27. Complejo Hospitalario Universitario de Ferrol, Gastroenterology, Ferrol, Spain. 28. Hospital Universitario German Trias I Pujol, Gastroenterology, Badalona, Spain. 29. Hospital Montecelo, Gastroenterology, Pontevedra, Spain. 30. Hospital de Montecelo, Radiology, Pontevedra, Spain. 31. Hospital Universitari Vall d'Hebron, Gastroenterology, Barcelona, Spain. 32. Hospital San Agustín, Gastroenterology, Avilés, Spain. 33. Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain. 34. Hospital Santa Bárbara, Gastroenterology, Soria, Spain. 35. Hospital Universitario Reina Sofía, Gastroenterology, Córdoba, Spain. 36. IMIBIC, Córdoba, Spain. 37. Hospital Puerta de Hierro, Gastroenterology, Madrid, Spain. 38. Hospital Universitario Infanta Elena, Gastroenterology, Valdemoro, Spain. 39. Osatek, Galdakao, Spain. 40. Hospital Royo Villanova, Gastroenterology, Zaragoza, Spain. 41. Hospital Universitario del Henares, Gastroenterology, Coslada, Spain. 42. Hospital Universitario del Henares, Radiology, Coslada, Spain. 43. Hospital Universitario Infanta Cristina, Gastroenterology, Parla, Spain. 44. Hospital Universitario Rey Juan Carlos, Gastroenterology, Móstoles, Spain. 45. Hospital Universitari Sant Joan de Reus, Gastroenterology, Reus, Spain. 46. Research Unit, Hospital de Galdakao. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC).
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.
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.
Entities:
Keywords:
Anti-TNF; Crohn’s disease; biologic drug; stricture; surgery
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