Magnetic resonance enterography findings as predictors of clinical outcome following antitumor necrosis factor treatment in small bowel Crohn’s disease

• Published in: European journal of gastroenterology & hepatology Vol. 27; no. 8; pp. 956 - 962
• Main Authors: Gibson, David J, Murphy, David J, Smyth, Anna E, McEvoy, Sinead H, Keegan, Denise, Byrne, Kathryn, Mulcahy, Hugh E, Cullen, Garret, Malone, Dermot E, Doherty, Glen A
• Format: Journal Article
• Language: English
• Published: England Copyright Wolters Kluwer Health, Inc. All rights reserved 01-08-2015
• Subjects: Adult; Anti-Inflammatory Agents - therapeutic use; Chi-Square Distribution; Crohn Disease - drug therapy; Crohn Disease - immunology; Crohn Disease - pathology; Crohn Disease - surgery; Disease Progression; Female; Gastrointestinal Agents - therapeutic use; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Intestine, Small - drug effects; Intestine, Small - immunology; Intestine, Small - pathology; Intestine, Small - surgery; Ireland; Kaplan-Meier Estimate; Magnetic Resonance Imaging - methods; Male; Multivariate Analysis; Predictive Value of Tests; Proportional Hazards Models; Retrospective Studies; Risk Factors; Time Factors; Treatment Failure; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor Necrosis Factor-alpha - immunology; Young Adult; Ireland
• ISSN: 0954-691X; 1473-5687
• DOI: 10.1097/MEG.0000000000000399

AIMSTo determine whether specific magnetic resonance enterography (MRE) findings can predict outcome following commencement of antitumor necrosis factor (aTNF) in small bowel Crohn’s disease (CD)
PATIENTS AND METHODSThis was a single-centre retrospective study of patients with CD who commenced aTNF (infliximab or adalimumab) between 2007 and 2013. Patients who had an MRE within 6 months before commencing aTNF were included. The primary end-point was the need for CD-related surgery. The secondary end-points were time to surgery and time to treatment failure. The relationship between these end-points, clinical variables and specific MRE findings were studied.
RESULTSFour hundred and eighteen patients commenced aTNF for CD during the study period. Seventy-five patients had an MRE within 6 months before commencing aTNF (30 infliximab; 45 adalimumab). The median time from MRE to commencing aTNF was 43 days (IQR 19.5–87 days). Eighteen of 75 (24%) had surgery during a median follow-up of 16.7 months (IQR 9.0–30.1 months). Patients with small bowel stenosis (SBS) on MRE were at a significantly higher risk of requiring surgery12/18 (66.7%) versus 6/57 (10.5%) (P<0.001). Time to surgery was significantly shorter in patients with SBS on MRE (P<0.001). In a multivariate analysis, SBS (P<0.0001, hazard ratio 26.45, 95% confidence interval 5.45–128.49) and presence of penetrating complications (P=0.003, hazard ratio 36.53, 95% confidence interval 3.40–393.19) were associated independently with time to surgery.
CONCLUSIONSBS and penetrating complications on MRE are associated independently with a need for early surgery and treatment failure in patients commencing aTNF.