December 31, 2019
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Treat-to-target measured by ultrasonography linked with better Crohn’s outcomes

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Small intestine contrast ultrasonographic assessment of mucosal healing can be an effective method to gauge response to anti-TNF therapy among patients with Crohn’s disease, according to study results.

Emma Calabrese, MD, PhD, of the gastroenterology unit at the University of Rome, and colleagues wrote that ultrasonography can reveal some of the transmural features of CD, including intestinal wall thickness, penetrating complications and hypervascularization.

“The STRIDE consensus recommended a treat-to target approach for CD based on resolution of symptoms and endoscopically assessed ulcerations, but cross-sectional imaging was acknowledged as an evolving target,” they wrote. “Recent studies demonstrated that transmural healing, defined as bowel ultrasonography as the normalization of the parietal thickness, could be achieved in about a quarter of CD patients treated with anti-TNFs. However, there is no specific definition of transmural healing assessed by cross-sectional imaging techniques.”

Researchers conducted an observational study comprising 80 patients with CD who received treatment with anti-TNF for at least 1 year. The patients underwent serial small intestine contrast ultrasonography (SICUS) at baseline and at 18 months of follow-up to evaluate the disease site, extent of lesions and presence of complications.

After follow-up, investigators categorized patients into three groups based on response; complete response, partial response and non-responders. Then, they assessed CD-related outcomes at 1 year from the second SICUS and analyzed them after long-term follow up at 5 years.

After 18 months of treatment, 36 patients were in complete response (51%), 30 were in partial response (34%) and 13 were non-responders (15%). At 1 year, none of the patients in the complete response group had undergone surgery compared with six partial responders (P = .0003) and five non-responders (P = .001).

Additionally, complete responders used smaller amounts of corticosteroids and required fewer hospitalizations than partial or non-responders.

In their analysis of long-term follow-up data, Calabrese and colleagues found that complete responders had a lower cumulative probability of need for surgery, hospitalization or need for steroids compared with non-responders (P < .0001, P = .003 and P = .0001, respectively).

“This study presents data to demonstrate the magnitude and significance of ultrasonographic response as a treatment target and monitoring tool,” they wrote. “More prospective controlled studies are needed to better define the definition of transmural healing or ultrasonographic response to evaluate the efficacy of new therapeutic agents and to delineate the clinical consequences of transmural healing or persistence of inflammatory lesions.” – by Alex Young

Disclosure: Calabrese reports serving as a speaker for AbbVie, Janssen and Takeda. Please see the full study for all other authors’ relevant financial disclosures.