Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease.
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Rodríguez-Lago Iago, Hoyo Javier Del, Pérez-Girbés Alexandre, Garrido-Marín Alejandro, Casanova María José, Chaparro María, Fernández-Clotet Agnès, Castro-Poceiro Jesús, García María José, Sánchez Sara, Ferreiro-Iglesias Rocío, Bastón Iria, Piqueras Marta, Careda Lola Esteba I Bech de, Mena Raquel, Suárez Cristina, Cordón Joaquín Poza, López-García Alicia, Márquez Lucía, Arroyo Maite, Alfambra Erika, Sierra Mónica, Cano Noelia, Delgado-Guillena Pedro, Morales-Alvarado Víctor, Aparicio Juan Carlos, Guerra Iván, Aulló Carolina, Merino Olga, Arranz Laura, Hidalgo María Araceli, Llaó Jordina, Plaza Rocío, Molina Gema, Torres Paola, Pérez-Galindo Pablo, Romero María Giselle, Herrera-deGuise Claudia, Armesto Edisa, Mesonero Francisco, Frago-Larramona Santiago, Benítez José Manuel, Calvo Marta, Martín María Del Carmen López, Elorza Ainara, Larena Alejandro, Peña Elena, Rodríguez-Grau María Del Carmen, Miguel-Criado Jaime de, Botella Belén, Olmos José Antonio, López Laura, Aguirre Urko, Gisbert Javier P, Young GETECCU Group
Аннотация
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.