Early treatment with anti‐tumor necrosis factor agents improves long‐term effectiveness in symptomatic stricturing Crohn’s disease
Year: 2020
Type: article
Study design: Observational Study
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: = 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.
Authors: Iago Rodríguez‐Lago, Javier Del Hoyo, Alexandre Pérez‐Girbés, Alejandro Garrido‐Marín, María José Casanova, María Chaparro, Agnès Fernández‐Clotet, Jesús Castro‐Poceiro, María José García, Sara Sánchez, Rocío Ferreiro‐Iglesias, Iria Bastón, Marta Piqueras, Lola Esteba i Bech de Careda, Raquel Mena, Cristina Suárez, Joaquín Poza Cordón, Alicia López‐García, Lucía Márquez, Maite Arroyo, Erika Alfambra, Mónica Sierra, Noelia Cano, Pedro Delgado‐Guillena, Víctor Morales‐Alvarado, Juan Carlos Aparicio, Iván Guerra, Carolina Aulló, Olga Merino, Laura Arranz, María Araceli Hidalgo, Jordina Llaó, Rocío Plaza, Gema Molina, Paola Torres, Pablo Pérez‐Galindo, María Giselle Romero, Claudia Herrera‐deGuise, Edisa Armesto, Francisco Mesonero, Santiago Frago‐Larramona, José Manuel Benítez, Marta Calvo, Carmen López Martín, Ainara Elorza, Alejandro Larena, Elena Peña, María del Carmen Rodríguez‐Grau, Jaime de Miguel‐Criado, Belén Botella, José Antonio Olmos, Laura López, Urko Aguirre, Javier P. Gisbert, Young GETECCU Group
Institutions: BioCruces Health research Institute, Hospital de Galdakao, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Hospital Clínic de Barcelona, Marqués de Valdecilla University Hospital, Complejo Hospitalario Universitario de Santiago, Consorci Sanitari de Terrassa, Hospital Universitario La Paz, Hospital Del Mar, Municipal Institute for Medical Research, Hospital del Mar Research Institute, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, Complejo Asistencial Universitario de León, Hospital General de Granollers, Hospital La Paz Institute for Health Research, Hospital Universitario de Fuenlabrada, Hospital de Cruces, Hospital Universitario Nuestra Señora de Candelaria, Althaia, Hospital Universitario Infanta Leonor, Complejo Hospitalario Universitario de Ferrol, Hospital Universitari Germans Trias i Pujol, Hospital Montecelo, Vall d'Hebron Hospital Universitari, Hospital Universitario San Agustín, Hospital Universitario Ramón y Cajal, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Hospital Universitario Puerta de Hierro Majadahonda, Hospital Royo Villanova, Hospital Universitario del Henares, Hospital Universitario Infanta Cristina, Hospital Universitario Rey Juan Carlos, Hospital Universitari Sant Joan de Reus, Red de Investigación en Servicios de Salud en Enfermedades Crónicas
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G2850342541, G3490649612
OpenAlex ID: W3045708145