Early treatment with anti‐tumor necrosis factor agents improves long‐term effectiveness in symptomatic stricturing Crohn’s disease
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- Iago Rodríguez‐Lago
- Hospital de Galdakao Gastroenterology Galdakao Spain
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- Javier Del Hoyo
- Hospital Universitari i Politècnic de La Fe Gastroenterology Valencia Spain
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- Alexandre Pérez‐Girbés
- Hospital Universitari i Politècnic de La Fe (Valencia) Radiology Valencia Spain
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- Alejandro Garrido‐Marín
- Hospital Universitari i Politècnic de La Fe Gastroenterology Valencia Spain
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- María José Casanova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Madrid Spain
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- María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Madrid Spain
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- Agnès Fernández‐Clotet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Madrid Spain
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- Jesús Castro‐Poceiro
- Hospital Clinic Gastroenterology Barcelona Spain
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- María José García
- Hospital Universitario Marqués de Valdecilla Gastroenterology Santander Spain
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- Sara Sánchez
- Hospital Universitario Marqués de Valdecilla Radiology Santander Spain
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- Rocío Ferreiro‐Iglesias
- Hospital Clínico Universitario de Santiago de Compostela Gastroenterology Santiago de Compostela Spain
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- Iria Bastón
- Hospital Clínico Universitario de Santiago de Compostela Gastroenterology Santiago de Compostela Spain
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- Marta Piqueras
- Consorci Sanitari de Terrassa Gastroenterology Terrassa Spain
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- Raquel Mena
- Consorci Sanitari de Terrassa Gastroenterology Terrassa Spain
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- Cristina Suárez
- Hospital Universitario La Paz Gastroenterology Madrid Spain
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- Joaquín Poza Cordón
- Hospital Universitario La Paz Gastroenterology Madrid Spain
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- Alicia López‐García
- Hospital del Mar Gastroenterology Barcelona Spain
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- Lucía Márquez
- Hospital del Mar Gastroenterology Barcelona Spain
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- Maite Arroyo
- IIS Aragón Hospital Clínico Universitario Lozano Blesa Gastroenterology Zaragoza Spain
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- Erika Alfambra
- IIS Aragón Hospital Clínico Universitario Lozano Blesa Gastroenterology Zaragoza Spain
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- Mónica Sierra
- Complejo Asistencial Universitario de León Gastroenterology León Spain
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- Noelia Cano
- Complejo Asistencial Universitario de León Gastroenterology León Spain
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- Pedro Delgado‐Guillena
- Hospital General de Granollers Gastroenterology Granollers Spain
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- Víctor Morales‐Alvarado
- Hospital General de Granollers Gastroenterology Granollers Spain
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- Juan Carlos Aparicio
- Hospital General de Granollers Radiology Granollers Spain
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- Iván Guerra
- Hospital Universitario de Fuenlabrada Gastroenterology Fuenlabrada Spain
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- Carolina Aulló
- Hospital Universitario de Fuenlabrada Radiology Fuenlabrada Spain
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- Olga Merino
- Hospital Universitario de Cruces Gastroenterology Barakaldo Spain
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- Laura Arranz
- Hospital Ntra. Sra. Candelaria Gastroenterology Santa Cruz de Tenerife Spain
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- María Araceli Hidalgo
- Hospital Ntra. Sra. Candelaria Radiology Santa Cruz de Tenerife Spain
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- Jordina Llaó
- Althaia Xarxa Assistencial Universitària de Manresa Gastroenterology Manresa Spain
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- Rocío Plaza
- Hospital Universitario Infanta Leonor Gastroenterology Madrid Spain
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- Gema Molina
- Complejo Hospitalario Universitario de Ferrol Gastroenterology Ferrol Spain
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- Paola Torres
- Hospital Universitario German Trias I Pujol Gastroenterology Badalona Spain
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- Pablo Pérez‐Galindo
- Hospital Montecelo Gastroenterology Pontevedra Spain
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- María Giselle Romero
- Hospital de Montecelo Radiology Pontevedra Spain
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- Claudia Herrera‐deGuise
- Hospital Universitari Vall d’Hebron Gastroenterology Barcelona Spain
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- Edisa Armesto
- Hospital San Agustín Gastroenterology Avilés Spain
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- Francisco Mesonero
- Hospital Universitario Ramón y Cajal Gastroenterology Madrid Spain
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- Santiago Frago‐Larramona
- Hospital Santa Bárbara Gastroenterology Soria Spain
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- José Manuel Benítez
- Hospital Universitario Reina Sofía Gastroenterology Córdoba Spain
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- Marta Calvo
- Hospital Puerta de Hierro Gastroenterology Madrid Spain
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- Carmen López Martín
- Hospital Universitario Infanta Elena Gastroenterology Valdemoro Spain
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- Ainara Elorza
- Hospital de Galdakao Gastroenterology Galdakao Spain
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- Alejandro Larena
- Osatek Galdakao Spain
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- Elena Peña
- Hospital Royo Villanova Gastroenterology Zaragoza Spain
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- María del Carmen Rodríguez‐Grau
- Hospital Universitario del Henares Gastroenterology Coslada Spain
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- Jaime de Miguel‐Criado
- Hospital Universitario del Henares Radiology Coslada Spain
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- Belén Botella
- Hospital Universitario Infanta Cristina Gastroenterology Parla Spain
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- José Antonio Olmos
- Hospital Universitario Rey Juan Carlos Gastroenterology Móstoles Spain
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- Laura López
- Hospital Universitari Sant Joan de Reus Gastroenterology Reus Spain
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- Urko Aguirre
- Research Unit Hospital de Galdakao. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)
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- Javier P. Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Madrid Spain
抄録
<jats:sec><jats:title>Background</jats:title><jats:p>There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn’s disease.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>The study aims to determine the effectiveness of anti‐tumor necrosis factor (TNF) agents in Crohn’s disease complicated with symptomatic strictures.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, 262 patients with Crohn’s disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab (<jats:italic>N</jats:italic> = 141, 54%) or adalimumab (<jats:italic>N</jats:italic> = 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>
収録刊行物
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- United European Gastroenterology Journal
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United European Gastroenterology Journal 8 (9), 1056-1066, 2020-11
Wiley
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キーワード
詳細情報 詳細情報について
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- CRID
- 1360861294732229376
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- ISSN
- 20506414
- 20506406
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- データソース種別
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- Crossref