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

Bodini, Giorgia; Giannini, Edoardo G.; Maria, Costanza De; Dulbecco, Pietro; Furnari, Manuele; Marabotto, Elisa; Savarino, Vincenzo; Savarino, Edoardo

doi:10.1016/j.dld.2016.10.014

Cited by 31 publications

(26 citation statements)

References 26 publications

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“…(13) All the other studies of the Lémann Index are retrospective and the published methodology for calculating the Lémann Index was not applied. (10,14‐16) Our study, using the published methodology, confirms that the Lémann Index increases with disease duration by assessing irreversible bowel damage as well as the accumulation of stricturing lesions, penetrating lesions and surgical resections. (8) Our results confirm that the Lémann Index identifies disease progression and we also identified other factors associated with more extensive bowel damage.…”

Section: Discussionsupporting

confidence: 62%

“…(8) The Lémann Index might be a powerful tool to measure the impact of therapeutic strategies on long‐term outcomes in CD, in particular to prevent the progression of bowel damage. (9,10) The IBD Disability Index was developed to quantify disability in a patient with IBD at a given time. (7) The French version of the IBD Disability Index was recently validated.…”

Section: Introductionmentioning

confidence: 99%

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Bowel damage and disability in Crohn's disease: a prospective study in a tertiary referral centre of the Lémann Index and Inflammatory Bowel Disease Disability Index

Prevost

Azahaf

Nachury

et al. 2020

Aliment Pharmacol Ther

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Background: The notion of Crohn's disease (CD) as a chronic, progressive and disabling condition has led to the development of new indexes: the Lémann Index measuring cumulative bowel damage and the Inflammatory Bowel Disease (IBD) Disability Index, assessing functional disability.Aims: To measure the Lémann Index and the IBD Disability Index in a large prospective cohort of CD patients and to assess the correlation between these two indexes. Methods:We performed a prospective study in a tertiary referral centre including all consecutive CD outpatients. We assessed the Lémann Index and the IBD Disability Index questionnaire in all patients. Results:One hundred and thirty CD patients were consecutively included. The mean Lémann Index (±SD) was 11.9 ± 14.1 and ranged from 0 to 72.5 points. Factors associated with a high bowel damage score were: disease duration, anal location, previous intestinal resection, clinical and biological disease activity, exposure to immunosuppressants, and exposure to anti-TNF (P < 0.005). Among patients exposed to anti-TNF, the Lémann Index was lower in those who were exposed in the first 2 years of their disease (P = 0.015). The mean IBD Disability Index was 28.8 ± 6.3 and ranged from 0 to 71 points. The factors associated with high disability score were: female gender, anal location, extra digestive manifestations, clinical and biological disease activity and exposure to anti-TNF (P < 0.005). No correlation was observed between the Lémann Index and IBD Disability Index (P = 0.15). Conclusions:This is the first study to prospectively evaluate the Lémann Index and the IBD Disability Index in a large cohort of CD patients in a tertiary centre. Early introduction of anti-TNF treatment was associated with lower bowel damage scores, and no correlation was observed between the Lémann Index and the IBD Disability Index. Further dedicated prospective studies are necessary to confirm these results.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Bowel damage and disability in Crohn's disease: a prospective study in a tertiary referral centre of the Lémann Index and Inflammatory Bowel Disease Disability Index

Prevost

Azahaf

Nachury

et al. 2020

Aliment Pharmacol Ther

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“…CD is characterized by a persistent transmural inflammatory with consequent CBD which progresses over time even in patients with apparent clinical remission of symptoms [7]. In the past, the main outcome of medical therapies for CD was the clinical remission, intended solely as a resolution of symptoms, while currently the objectives are much more complex, including histological remission and halting the progression of CBD [8].…”

Section: Discussionmentioning

confidence: 99%

Adalimumab versus azathioprine to halt the progression of bowel damage in Crohn’s disease: application of Lémann Index

Ribaldone

Caviglia

Pellicano

et al. 2019

Scandinavian Journal of Gastroenterology

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Background: The Lémann Index was recently developed to evaluate the cumulative bowel damage in patients with Crohn's disease. Aims: To search for a difference between adalimumab and azathioprine to halt the progression of bowel damage in active Crohn's disease, using the Lémann Index. Methods: A single-centre, retrospective study was conducted. Patients with Crohn's disease were included if they had colonoscopy and magnetic resonance enterography performed within 4 months from the start of adalimumab or azathioprine, and repeated after 12 months of therapy. Primary outcome was reached if the increase of Lémann Index after 12 months of treatment was < 0.3, the drug was not stopped, and the use of systemic steroids was continued for no more than 3 months. Results: Ninety-one patients were enrolled, 31 (34.1%) of them treated with adalimumab and 60 (65.9%) with azathioprine. Sixty-seven percent of patients treated with adalimumab reached the primary outcome compared to 28.3% of patients treated with azathioprine (p = 0.0006). The Lémann Index in the group on adalimumab therapy decreased after 12 months (from 9.9 to 8.8), while in the group on azathioprine therapy it increased (from 7.7 to 8.8). Conclusion: Treatment with adalimumab halts the progression of bowel damage in Crohn's disease while that with azathioprine does not.

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“…Stopping or attenuating of inflammation at an early stage, might therefore prevent the ongoing progression of scar tissue formation, wall thickening, luminal narrowing and thus the development of stenosis over time [35][36][37]. In contrast, penetrating disease might manifest more suddenly at any time in the course of the disease [38], turning it out to be less susceptible to modification by early anti-TNF treatment.…”

Section: Discussionmentioning

confidence: 99%

Early Initiation of Anti-TNF is Associated with Favourable Long-term Outcome in Crohn’s Disease: 10-Year-Follow-up Data from the Swiss IBD Cohort Study

Frei

Fournier

Zeitz

et al. 2019

Journal of Crohn's and Colitis

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Background and Aims The optimal timing of treatment escalation in Crohn’s disease [CD] remains a challenging issue, and very little is known about its long-term development following early versus late administration of anti-TNF antibodies. The long-term outcome of Swiss CD patients was comparatively assessed in an up to 10-year follow-up, using patients participating in the Swiss Inflammatory Bowel Disease Cohort Study [SIBDCS]. Methods Prospectively collected SIBDCS patient data, including disease history, baseline characteristics at enrolment, and course of disease, were analysed in patients with early versus late [<24 versus ≥24 months after diagnosis] and no anti-TNF treatment. Results A reduced risk of developing bowel stenosis was found in patients who received early anti-TNF treatment. This association was seen in patients overall and also in the subgroups of CD patients without pre-existing complications [Log-rank test: p < 0.001]. Furthermore, osteoporosis and anaemia were observed significantly less frequently in patients who received early anti-TNF treatment, compared with either patients who received treatment late [p < 0.001 and p = 0.046, respectively] or were never [p < 0.001 for both] treated with anti-TNF antibodies. Patients with early anti-TNF administration sought medical consultations significantly less often, including gastroenterologists in private practice [p = 0.017], ambulatory [outpatient] hospital visits [p = 0.038], and a composite of any medical visits [p = 0.001]. The percentage of patients unable to work was lowest for early-anti-TNF–treated patients, in comparison with patients who were treated late or never [3.6% vs 8.8% vs 3.7%, p = 0.016]. Conclusions In CD patients within the SIBDCS, early anti-TNF administration was found to be associated with several indicators of a more favourable long-term outcome.

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

Cited by 31 publications

References 26 publications

Bowel damage and disability in Crohn's disease: a prospective study in a tertiary referral centre of the Lémann Index and Inflammatory Bowel Disease Disability Index

Bowel damage and disability in Crohn's disease: a prospective study in a tertiary referral centre of the Lémann Index and Inflammatory Bowel Disease Disability Index

Adalimumab versus azathioprine to halt the progression of bowel damage in Crohn’s disease: application of Lémann Index

Early Initiation of Anti-TNF is Associated with Favourable Long-term Outcome in Crohn’s Disease: 10-Year-Follow-up Data from the Swiss IBD Cohort Study

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