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

被引：40

作者：

Rodriguez-Lago, Iago ^{[1
,2
]}

Hoyo, Javier Del ^{[3
,4
]}

Perez-Girbes, Alexandre ^{[5
]}

Garrido-Marin, Alejandro ^{[3
]}

Casanova, Maria Jose ^{[4
,6
,7
]}

Chaparro, Maria ^{[4
,6
,7
]}

Fernandez-Clotet, Agnes ^{[4
,8
]}

Castro-Poceiro, Jesus ^{[8
]}

Garcia, Maria Jose ^{[9
]}

Sanchez, Sara ^{[10
]}

Ferreiro-Iglesias, Rocio ^{[11
]}

Baston, Iria ^{[11
]}

Piqueras, Marta ^{[12
]}

Careda, Lola Esteba i Bech de Careda ^{[13
]}

Mena, Raquel ^{[12
]}

Suarez, Cristina ^{[14
]}

Cordon, Joaquin Poza ^{[14
]}

Lopez-Garcia, Alicia ^{[15
,16
]}

Marquez, Lucia ^{[15
,16
]}

Arroyo, Maite ^{[4
,17
]}

Alfambra, Erika ^{[4
,17
]}

Sierra, Monica ^{[18
]}

Cano, Noelia ^{[18
]}

Delgado-Guillena, Pedro ^{[19
]}

Morales-Alvarado, Victor ^{[19
]}

Aparicio, Juan Carlos ^{[20
]}

Guerra, Ivan ^{[21
,22
]}

Aullo, Carolina ^{[23
]}

Merino, Olga ^{[24
]}

Arranz, Laura ^{[25
]}

Hidalgo, Maria Araceli ^{[26
]}

Llao, Jordina ^{[27
]}

Plaza, Rocio ^{[28
]}

Molina, Gema ^{[29
]}

Torres, Paola ^{[30
]}

Perez-Galindo, Pablo ^{[31
]}

Romero, Maria Giselle ^{[32
]}

Herrera-deGuise, Claudia ^{[33
]}

Armesto, Edisa ^{[34
]}

Mesonero, Francisco ^{[35
]}

Frago-Larramona, Santiago ^{[36
]}

Benitez, Jose Manuel ^{[37
,38
]}

Calvo, Marta ^{[39
]}

Martin, Maria del Carmen Lopez ^{[40
]}

Elorza, Ainara ^{[1
,2
]}

Larena, Alejandro ^{[41
]}

Pena, Elena ^{[42
]}

Rodriguez-Grau, Maria del Carmen ^{[43
]}

Miguel-Criado, Jaime de ^{[44
]}

Botella, Belen ^{[45
]}

机构：

[1] Hosp Galdakao, Gastroenterol, Galdakao, Spain

[2] Biocruces Bizkaia Hlth Res Inst, Baracaldo, Spain

[3] Hosp Univ & Politecn La Fe, Gastroenterol, Valencia, Spain

[4] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain

[5] Hosp Univ & Politecn La Fe Valencia, Radiol, Valencia, Spain

[6] Hosp Univ La Princesa, Gastroenterol, Madrid, Spain

[7] Univ Autonoma Madrid UAM, Inst Invest Sanit Princesa IIS IP, Madrid, Spain

[8] Hosp Clin Barcelona, Gastroenterol, Barcelona, Spain

[9] Hosp Univ Marques Valdecilla, Gastroenterol, Santander, Spain

[10] Hosp Univ Marques Valdecilla, Radiol, Santander, Spain

[11] Hosp Clin Univ Santiago De Compostela, Gastroenterol, Santiago De Compostela, Spain

[12] Consorci Sanit Terrassa, Gastroenterol, Terrassa, Spain

[13] Consorci Sanit Terrassa, Radiol, Terrassa, Spain

[14] Hosp Univ La Paz, Gastroenterol, Madrid, Spain

[15] Hosp del Mar, Gastroenterol, Barcelona, Spain

[16] Hosp del Mar, Med Res Inst IMIM, Barcelona, Spain

[17] Hosp Clin Univ Lozano Blesa, IIS Aragon, Gastroenterol, Zaragoza, Spain

[18] Complejo Asistencial Univ Leon, Gastroenterol, Leon, Spain

[19] Hosp Gen Granollers, Gastroenterol, Granollers, Spain

[20] Hosp Gen Granollers, Radiol, Granollers, Spain

[21] Hosp Univ Fuenlabrada, Gastroenterol, Fuenlabrada, Spain

[22] Inst Invest La Paz IdiPaz, Madrid, Spain

[23] Hosp Univ Fuenlabrada, Radiol, Fuenlabrada, Spain

[24] Hosp Univ Cruces, Gastroenterol, Baracaldo, Spain

[25] Hosp Ntra Sra Candelaria, Gastroenterol, Santa Cruz De Tenerife, Spain

[26] Hosp Ntra Sra Candelaria, Radiol, Santa Cruz De Tenerife, Spain

[27] Xarxa Assistencial Univ Manresa, Althaia, Gastroenterol, Manresa, Spain

[28] Hosp Univ Infanta Leonor, Gastroenterol, Madrid, Spain

[29] Complejo Hosp Univ Ferrol, Gastroenterol, Ferrol, Spain

[30] Hosp Badalona Germans Trias & Pujol, Gastroenterol, Badalona, Spain

[31] Hosp Montecelo, Gastroenterol, Pontevedra, Spain

[32] Hosp Montecelo, Radiol, Pontevedra, Spain

[33] Hosp Univ Vall dHebron, Gastroenterol, Barcelona, Spain

[34] Hosp San Agustin, Gastroenterol, Aviles, Spain

[35] Hosp Univ Ramon y Cajal, Gastroenterol, Madrid, Spain

[36] Hosp Santa Barbara, Gastroenterol, Soria, Spain

[37] Hosp Univ Reina Sofia, Gastroenterol, Cordoba, Spain

[38] IMIBIC, Cordoba, Spain

[39] Hosp Puerta Hierro, Gastroenterol, Madrid, Spain

[40] Hosp Univ Infanta Elena, Gastroenterol, Valdemoro, Spain

[41] Osatek, Galdakao, Spain

[42] Hosp Royo Villanova, Gastroenterol, Zaragoza, Spain

[43] Hosp Univ Henares, Gastroenterol, Coslada, Spain

[44] Hosp Univ Henares, Radiol, Coslada, Spain

[45] Hosp Univ Infanta Cristina, Gastroenterol, Parla, Spain

[46] Hosp Univ Rey Juan Carlos, Gastroenterol, Mostoles, Spain

[47] Hosp Univ Sant Joan Reus, Gastroenterol, Reus, Spain

[48] Hosp Galdakao, Res Unit, Red Invest Serv Salud Enfermedades Cron REDISSEC, Galdakao, Spain

来源：

UNITED EUROPEAN GASTROENTEROLOGY JOURNAL | 2020年 / 8卷 / 09期

关键词：

Anti-TNF; biologic drug; Crohn's disease; stricture; surgery; BOWEL DAMAGE; EFFICACY; FIBROSIS; IMMUNOMODULATORS; INFLAMMATION; ANTAGONISTS; MANAGEMENT; MECHANISMS; INFLIXIMAB; CONSENSUS;

D O I：

10.1177/2050640620947579

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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.

引用

页码：1056 / 1066

页数：11

共 28 条

[11] 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management [J].

Gomollon, Fernando ;

Dignass, Axel ;

Annese, Vito ;

Tilg, Herbert ;

Van Assche, Gert ;

Lindsay, James O. ;

Peyrin-Biroulet, Laurent ;

Cullen, Garret J. ;

Daperno, Marco ;

Kucharzik, Torsten ;

Rieder, Florian ;

Almer, Sven o ;

Armuzzi, Alessandro ;

Harbord, Marcus ;

Langhorst, Jost ;

Sans, Miquel ;

Chowers, Yehuda ;

Fiorino, Gionata ;

Juillerat, Pascal ;

Mantzaris, Gerassimos J. ;

Rizzello, Fernando ;

Vavricka, Stephan ;

Gionchetti, Paolo .

JOURNAL OF CROHNS & COLITIS, 2017, 11 (01) :3-25

[12] Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support [J].

Harris, Paul A. ;

Taylor, Robert ;

Thielke, Robert ;

Payne, Jonathon ;

Gonzalez, Nathaniel ;

Conde, Jose G. .

JOURNAL OF BIOMEDICAL INFORMATICS, 2009, 42 (02) :377-381

[13] Factors associated with the development of intestinal strictures or obstructions in patients with .Crohn's disease [J].

Lichtenstein, Gary R. ;

Olson, Allan ;

Travers, Suzanne ;

Diamond, Robert H. ;

Chen, Donny M. ;

Pritchard, Michelle L. ;

Feagan, Brian G. ;

Cohen, Russell D. ;

Salzberg, Bruce A. ;

Hanauer, Stephen B. ;

Sandborn, William J. .

AMERICAN JOURNAL OF GASTROENTEROLOGY, 2006, 101 (05) :1030-1038

[14]

Louis E, 2007, ACTA GASTRO-ENT BELG, V70, P15

[15] Is it Possible to Change Phenotype Progression in Crohn's Disease in the Era of Immunomodulators? Predictive Factors of Phenotype Progression [J].

Magro, Fernando ;

Rodrigues-Pinto, Eduardo ;

Coelho, Rosa ;

Andrade, Patricia ;

Santos-Antunes, Joao ;

Lopes, Susana ;

Camila-Dias, Claudia ;

Macedo, Guilherme .

AMERICAN JOURNAL OF GASTROENTEROLOGY, 2014, 109 (07) :1026-1036

[16] Bowel damage and disability in Crohn's disease: a prospective study in a tertiary referral centre of the Lemann Index and Inflammatory Bowel Disease Disability Index [J].

Prevost, Clementine Lauriot Dit ;

Azahaf, Mustapha ;

Nachury, Maria ;

Branche, Julien ;

Gerard, Romain ;

Wils, Pauline ;

Lambin, Thomas ;

Desreumaux, Pierre ;

Ernst, Olivier ;

Pariente, Benjamin .

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2020, 51 (09) :889-898

[17] An expert consensus to standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Crohn's disease [J].

Rieder, F. ;

Bettenworth, D. ;

Ma, C. ;

Parker, C. E. ;

Williamson, L. A. ;

Nelson, S. A. ;

van Assche, G. ;

Di Sabatino, A. ;

Bouhnik, Y. ;

Stidham, R. W. ;

Dignass, A. ;

Rogler, G. ;

Taylor, S. A. ;

Stoker, J. ;

Rimola, J. ;

Baker, M. E. ;

Fletcher, J. G. ;

Panes, J. ;

Sandborn, W. J. ;

Feagan, B. G. ;

Jairath, V. .

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2018, 48 (03) :347-357

[18] Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases [J].

Rieder, Florian ;

Fiocchi, Claudio ;

Rogler, Gerhard .

GASTROENTEROLOGY, 2017, 152 (02) :340-+

[19]

Rimola J, 2015, AM J GASTROENTEROL, V110, P432, DOI 10.1038/ajg.2014.424

[20] The Role of Immunomodulators and Biologics in the Medical Management of Stricturing Crohn's Disease [J].

Rodriguez-Lago, Iago ;

Gisbert, Javier P. .

JOURNAL OF CROHNS & COLITIS, 2020, 14 (04) :557-566

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