Jordi Rimola1,2, Agnès Fernàndez-Clotet2,3, Nunzia Capozzi1,4, Sònia Rojas-Farreras5, Ignacio Alfaro3,6, Sonia Rodríguez1, Maria-Carme Masamunt3,7, Elena Ricart2,3,7,8, Ingrid Ordás2,3,7,8, Julian Panés2,3,7,8. 1. Radiology Department IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain. 2. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain. 3. Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain. 4. Radiology Department, Policlinico Universitario Sant'Orsola-Malpighi, Bologna, Italy. 5. Statistician Freelance, Barcelona, Spain. 6. Gastroenterology Department, Hospital regional de Concepción, Concepcion, Chile. 7. Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 8. University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Identifying predictors of therapeutic response is the cornerstone of personalised medicine. AIM: To identify predictors of long-term healing of severe inflammatory lesions based on magnetic resonance enterography (MRE) findings in patients with Crohn's disease (CD) treated with tumour necrosis factor alpha (TNF-α) inhibitors. METHODS: This prospective longitudinal single-centre study included patients with clinically active CD requiring treatment with TNF-α inhibitors with at least one intestinal segment with a severe inflammatory lesion detected by MRE (segmental MaRIA ≥11). MRE data were obtained at baseline, and at weeks 14 and 46. The primary endpoint was healing of severe inflammatory lesions (MaRIA <11) in each segment. The secondary endpoint was healing of all severe inflammatory lesions on a per-patient analysis. RESULTS: We included 58 patients with 86 intestinal segments with severe inflammatory lesions. At week 46, healing of severe lesions was found in 51/86 (59.3%) segments, and complete healing of inflammatory lesions in all segments was found in 28/58 (48.6%) patients. Multivariable analysis found baseline-negative predictors of long-term healing of severe inflammation were ileal (as opposed to colonic) location (OR 0.00, [0.00-0.56] P = 0.002) and presence of creeping fat on MRE (OR 0.00 [0.00-0.57]; P = 0.001). Persistence of segmental MaRIA score >10.6 at week 14 was a negative predictor of healing at week 46 (OR 0.3 [0.04--0.38]; P < 0.001). CONCLUSION: In patients with CD, the absence of creeping fat detected at baseline MRE and location of severe inflammatory lesions are clinically relevant predictors of long-term healing of severe inflammation under treatment with TNF-α inhibitors.
BACKGROUND: Identifying predictors of therapeutic response is the cornerstone of personalised medicine. AIM: To identify predictors of long-term healing of severe inflammatory lesions based on magnetic resonance enterography (MRE) findings in patients with Crohn's disease (CD) treated with tumour necrosis factor alpha (TNF-α) inhibitors. METHODS: This prospective longitudinal single-centre study included patients with clinically active CD requiring treatment with TNF-α inhibitors with at least one intestinal segment with a severe inflammatory lesion detected by MRE (segmental MaRIA ≥11). MRE data were obtained at baseline, and at weeks 14 and 46. The primary endpoint was healing of severe inflammatory lesions (MaRIA <11) in each segment. The secondary endpoint was healing of all severe inflammatory lesions on a per-patient analysis. RESULTS: We included 58 patients with 86 intestinal segments with severe inflammatory lesions. At week 46, healing of severe lesions was found in 51/86 (59.3%) segments, and complete healing of inflammatory lesions in all segments was found in 28/58 (48.6%) patients. Multivariable analysis found baseline-negative predictors of long-term healing of severe inflammation were ileal (as opposed to colonic) location (OR 0.00, [0.00-0.56] P = 0.002) and presence of creeping fat on MRE (OR 0.00 [0.00-0.57]; P = 0.001). Persistence of segmental MaRIA score >10.6 at week 14 was a negative predictor of healing at week 46 (OR 0.3 [0.04--0.38]; P < 0.001). CONCLUSION: In patients with CD, the absence of creeping fat detected at baseline MRE and location of severe inflammatory lesions are clinically relevant predictors of long-term healing of severe inflammation under treatment with TNF-α inhibitors.
Authors: Allison D Ta; Nicholas J Ollberding; Rebekah Karns; Yael Haberman; Adina L Alazraki; David Hercules; Robert Baldassano; James Markowitz; Melvin B Heyman; Sandra Kim; Barbara Kirschner; Jason M Shapiro; Joshua Noe; Maria Oliva-Hemker; Anthony Otley; Marian Pfefferkorn; Richard Kellermayer; Scott Snapper; Shervin Rabizadeh; Ramnik Xavier; Marla Dubinsky; Jeffrey Hyams; Subra Kugathasan; Anil G Jegga; Jonathan R Dillman; Lee A Denson Journal: Inflamm Bowel Dis Date: 2021-10-20 Impact factor: 5.325