Evaluation of bowel wall thickness by ultrasound as early diagnostic tool for therapeutic response in Crohn’s disease patients treated with ustekinumab

Abstract

Background Ustekinumab was approved for the treatment of patients with moderate to severe CD 2. Development of predictors for selecting patients responding to ustekinumab has to be the next step. US offers a noninvasive method with great sensitivity in detecting CD activity 11. Aim To evaluate BWT by BS as early diagnostic tool for treatment response in CD patients treated with ustekinumab at week 8. Methods This is a prospective monocentric study. Twenty-three CD patients had BS at the time of first and second application. BS was performed by one of 2 experienced DEGUM certificated sonographers, with evaluation by both independently and blindly. Primary endpoint was substantial sonographic response defined as decrease of BWT ≥ 1 mm. Secondary endpoint was concordance between sonographic and clinical response, defined as decrease of CDAI ≥ 70 points and sonographic and biochemical response defined as decrease of CRP ≥ 0.5 mg/dl. Results At week 8, BS detected in 10 of 23 patients a substantial decrease of BWT ≥ 1 mm; in 7, a decrease < 1 mm. Compared to baseline, all 17 patients showed generally improved blood data and 16/17 generally improved clinical data. Of those with a decrease of BWT ≥ 1 mm, we observed a substantial decrease of CDAI ≥ 70 points in 9/10 patients and a substantial decrease of CRP ≥ 0.5 mg/dl in 8/10 patients. Conclusion Our study suggests that sonographic measurement of BWT can be a helpful parameter for selecting patients responding early to ustekinumab and for providing assistance in terms of further treatment interval at week 8.

Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases—A Systematic Review

“…For instance, for TI, both 2 and 3 mm have been used as cut-offs, while 3 or 4 mm values have been considered for colonic disease [24,26,[28][29][30][31][32][33][34]99]. For CDS, some studies have attempted to semi-quantitatively approximate the degree of hypervascularisation by using the Limberg score, while other authors preferred a dichotomous approach, with present or absent CDS [10,23,32,48,78]. Considering the many available abnormal findings, the decision on which parameters to follow is difficult and requires unification.…”

“…CDS is semi-quantitatively measured according to the Limberg score in five grades, from normal bowel wall with no vascular markings (grade 0) to long streaks of Doppler signal in the bowel wall extending to the mesentery (grade 4). It can also be dichotomised into two groups: normal (grades 0 and 1) and pathological CDS (≥grade 2) [23].…”

Multimodal dynamic ultrasound approach as predictor of response in patients with Crohn’s disease treated with ustekinumab

“…This is in contrast with previous reported data. Hoffmann et al 28 showed that patients with clinical and serological improvement had a decrease of BWT ⩾ 1 mm 8 weeks after the beginning of UST. More recently, a sub-study from the STARDUST (Study of Treat to Target versus Routine Care Maintenance Strategies in CD Patients Treated with Ustekinumab) trial found a statistically significant agreement between BWT and endoscopic SES-CD at week 48, with a NPV ranging from 73 to 80 at the different time points.…”

Intestinal stiffness in Crohn’s disease treated by biologics: Comparison of ustekinumab and infliximab using ultrasound shear wave elastography

“…BWT would be useful to monitor biologics-induced bowel activity improvement in CD. [ 15,28,43] There is an increase in echogenicity of the third layer of the intestinal wall (submucosal layer) that is currently thought to be an expression of submucosal brosis, whereas hypoechogenicity of the intestinal layers is related to hyperemia and edema. [44,45] Increased BWT are important components of in ammation, [ 46] and improvement lesions are generally de ned as those with improvement (> 1mm) or normalization of BWT.…”