Earlier Anti-Tumor Necrosis Factor Therapy of Crohn’s Disease Correlates with Slower Progression of Bowel Damage

Panchal, Hinaben J.; Wagner, Mathilde; Chatterji, Manjil; Taouli, Bachir; McBride, Russell; Patterson, Jeromy; Ungaro, Ryan C.; Dubinsky, Marla; Cho, Judy H.; Sachar, David B.

doi:10.1007/s10620-018-5434-4

Cited by 22 publications

(20 citation statements)

References 28 publications

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“…However, one study showed that early treatment did not reduce the rate of IBD complications in early versus late/conventional treatment group . Four additional studies showed potential value of early treatment with lower loss of efficacy, decreased time to treatment failure, slower rate of disease progression and improvement in mean HBI scores . A small study showed 91% CR rate in an early treatment group .…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Ungaro

Aggarwal

Topaloglu

et al. 2020

Aliment Pharmacol Ther

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Background: There is an increasing body of evidence showing that earlier use of biologics improves clinical outcomes in Crohn's disease (CD). Aim:To perform a systematic review and meta-analysis to assess the impact of early biologic use in the treatment of CD. Methods: PubMed and Embase databases were searched for English language papers and conference abstracts published through April 30, 2019. Studies were selected for inclusion if patients initiated biologics within 2 years of a CD diagnosis or if earlier biologics use (top-down) was compared with a conventional step-up strategy. Randomeffects meta-analyses were conducted to compare clinical remission (CR), relapse and endoscopic healing rates between early biologic treatment (<2 years of disease duration or top-down treatment strategy) and late/conventional treatment (biologic use after >2 years of disease duration or conventional step-up treatment strategy).Results: A total of 3069 records were identified, of which 47 references met the selection criteria for systematic review. A total of 18 471 patients were studied, with a median follow-up of 64 weeks (range 10-416). Meta-analysis found that early use of biologics was associated with higher rates of clinical remission (OR 2.10 [95% CI:1.69-2.60], n = 2763, P < 0.00001), lower relapse rates (OR 0.31 [95% CI: 0.14-0.68], n = 596, P = 0.003) and higher mucosal healing rates (OR 2.37 [95% CI: 1.78-3.16], n = 994, P < 0.00001) compared with late/conventional management. Conclusions:Early biologic treatment is associated with improved clinical outcomes in both adult and paediatric CD patients, not only in prospective clinical trials but also in real-world settings.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Ungaro

Aggarwal

Topaloglu

et al. 2020

Aliment Pharmacol Ther

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“…There are still few studies in literature focusing on the course of LI following a therapy with biological or immunosuppressive agents. Two recent clinical trials have demonstrated the significant halt of CBD progression in a subgroup of CD patients after 12 months of treatment with an anti-tumor necrosis factor (TNF) drug (p = 0.007 and p = 0.043, respectively) [4,5].…”

Section: Introductionmentioning

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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“…In recent years, the Lémann index has been used frequently as a valid tool to monitor BD progression [11][12][13]16 . The present study is the rst to investigate the in uence of different medical therapies on the LI score in consecutive patients with early CD, and identi ed predictors for short-term bowel resection.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Earlier use of biological agents tended to slow down the progression of BD. 13 Targeting early CD might be the best way to change the disease course and maximize patient bene t. Unfortunately, patients with CD often experience a delay in diagnosis, which is associated with an increased risk of BD over time. 7,8 The Paris de nition describes early CD as having a disease duration less than or equal to 18 months, without a history of previous treatment using disease-modifying agents (e.g., biologics, immunomodulators).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Early Intervention on the Bowel Damage and Intestinal Surgery of Crohn’s Disease, Based on the Lémann Index

Zhu

Feng

et al. 2020

Preprint

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Background: Clinicians aim to prevent progression of Crohn’s disease (CD); however, many patients require surgical resection because of cumulative bowel damage. The aim of this study was to evaluate the impact of early intervention on bowel damage in patients with CD using the Lémann Index and to identify bowel resection predictors. Methods: We analyzed consecutive patients with CD retrospectively. The Lémann Index was determined at the point of inclusion and at follow-up termination. The Paris definition was used to subdivide patients into early and late CD groups. Results: We included 154 patients, comprising 70 with early CD and 84 with late CD. After follow-up for 17.0 months, more patients experienced a decrease in the Lémann Index (61.4% vs. 42.9%), and fewer patients showed an increase in the Lémann Index (20% vs. 35.7%) in the early compared with the late CD group. Infliximab and other therapies reversed bowel damage to a greater extent in early CD patients than in late CD patients. Twenty-two patients underwent intestinal surgery, involving 5 patients in the early CD group and 17 patients in the late CD group. Three independent predictors of bowel resection were identified: baseline Lémann index ≥ 8.99, disease behavior B1, and history of intestinal surgery. Conclusions: Early intervention within 18 months after CD diagnosis could reverse bowel damage and decrease short-term intestinal resection. Patients with CD with a history of intestinal surgery, and/or a Lémann Index > 8.99 should be treated aggressively and monitored carefully to prevent progressive bowel damage.

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Earlier Anti-Tumor Necrosis Factor Therapy of Crohn’s Disease Correlates with Slower Progression of Bowel Damage

Cited by 22 publications

References 28 publications

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

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

Efficacy of Early Intervention on the Bowel Damage and Intestinal Surgery of Crohn’s Disease, Based on the Lémann Index

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