Anti-TNF therapy is able to stabilize bowel damage progression in patients with Crohn’s disease. A study performed using the Lémann Index

• Published in: Digestive and liver disease Vol. 49; no. 2; pp. 175 - 180
• Main Authors: Bodini, Giorgia, Giannini, Edoardo G, De Maria, Costanza, Dulbecco, Pietro, Furnari, Manuele, Marabotto, Elisa, Savarino, Vincenzo, Savarino, Edoardo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-02-2017
• Subjects: Adalimumab; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Azathioprine - therapeutic use; Colonoscopy; Crohn Disease - drug therapy; Crohn Disease - pathology; Disease Progression; Female; Follow-up; Gastroenterology and Hepatology; Humans; Immunosuppressive Agents - therapeutic use; Inflammatory bowel disease; Infliximab; Intestines - pathology; Italy; Magnetic Resonance Imaging; Male; Mesalamine - therapeutic use; Middle Aged; Retrospective Studies; Severity of Illness Index; Tomography, X-Ray Computed; Treatment; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Young Adult; Inflammatory bowel disease; Treatment; Infliximab; Adalimumab; Follow-up
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2016.10.014

Abstract Aims The Lémann Index (LI) was developed to assess the cumulative structural damage of the intestinal tract in patients with Crohn’s Disease (CD) independently of clinical and biochemical activity. Recently, the goal of CD focused on obtaining mucosal healing and deep remission rather than simple symptom control. These new therapeutic aims emphasize the need to prevent progression of bowel damage. In this study we aimed to evaluate the influence of different treatments on structural damage progression, assessed by means of LI in a series of CD patients consistently treated with various drugs. Methods The LI was calculated at inclusion and at the end of follow-up in 104 CD patients subdivided according to treatments received: biological drugs (n = 40, 38.4%), azathioprine (n = 19, 18.3%), and mesalazine (n = 45, 43.3%). Results The median follow-up was 29 months, with no difference among groups. During follow-up, the median LI was stable in the biological group [from 6.3 (range, 0.6–37.3) to 6.4 (range, 0.6–37.6), P = 0.543], whereas it significantly increased from 4.1 (range, 0.6–30) to 8.3 (range, 0.6–31.8) in the azathioprine group ( P = 0.0006), and from 2.4 (range, 0.6–25.8) to 4.1 (range, 0.6–28.8) in the mesalazine group ( P < 0.0001). Also during follow-up the LI increased significantly ( P = 0.004) in the azathioprine (68.4%) and mesalazine (60.0%) groups as compared with the biological therapy group (30.0%). Conclusions In CD patients the LI tends to increase over time, although the use of biological drugs rather than azathioprine or mesalazine seems to be able to reduce the progressive bowel damage.