Magnetic resonance enterographic predictors of one-year outcome in ileal and ileocolonic Crohn’s disease treated with anti-tumor necrosis factor antibodies

Abstract

The aim of the study was to assess the role of magnetic resonance enterography (MRE) in predicting one-year efficacy of anti-tumor necrosis factor antibodies - infliximab (IFX), adalimumab (ADA) in Crohn’s disease (CD) patients primarily responding to therapy. We performed retrospective analysis among 61 CD patients who had undergone a successful IFX/ADA induction therapy and were treated with maintenance doses. All patients underwent MRE at week 0. We assessed which MRE features were predictive for steroid-free remission at week 52, and which were associated with a secondary loss of response. 44 patients were in steroid-free remission at week 52, 17 - were secondary non-responders. The ROC curve showed that bowel thickening with contrast enhancement analyzed together at week 0 were associated with steroid-free remission at week 52 (p = 0.01; AUC 0.67). Bowel stenosis with or without prestenotic dilatation [OR 5.8 (95% CI 1.4 – 25) and 2.4 (95% CI 1.2 – 5) respectively; p = 0.01] and the presence of intra-abdominal fistulas [OR 1.4 (95% CI 1.1 – 2); p = 0.004] were related to secondary non-response. A high baseline inflammatory activity detected by MRE predicts one-year response in CD after IFX/ADA. In case of bowel stenosis, intra-abdominal fistulas, other therapeutic options should be considered.

Prediction of complicated disease course for children newly diagnosed with Crohn's disease: a multicentre inception cohort study

“…The mucosa overlying established Crohn’s disease strictures has a pro-fibrotic pattern of gene expression. 24 Whether ileal gene signatures would reveal these processes at an uncomplicated stage of disease was unknown. We detected a pronounced extracellular matrix gene signature in patients who ultimately progressed to strictures.…”

“…In particular, the possible underestimation of children with early fibrosis at diagnosis could explain why anti-TNFα therapy did not affect progression to stricturing. 24,29 Most participants had endoscopic ileal inflammation and so biopsies were taken from inflamed tissue. However, we were not able to obtain ileal biopsies from inflamed and non-inflamed segments in the same patients, and so cannot directly address the degree to which acute inflammation affected the gene signatures.…”

Magnetic resonance imaging and Crohn’s disease endoscopic index of severity: Correlations and concordance

“…Other MRI evaluations, such as mucosal ulcer and ADC value, were used in recent studies[ 22 ]. Some studies[ 23 - 27 ] focused on the accuracy of MRI indicators for the evaluation of CD and the response to medical therapy. One study reported that changes in CD clinical activity were significantly correlated with changes in MRI activity score[ 28 ].…”

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

“…Despite apparent symptom resolution, an active disease process often continues, accruing irreversible damage over time [6]. Advanced body-imaging techniques such as magnetic resonance enterography (MRE) and computed tomography enterography (CTE) allow detailed assessment of structural changes incurred as a result of the ongoing disease process (e.g., mucosal enhancement, bowel wall thickness) [7]. The Lémann index (Li) is a recently introduced objective quantitative measure of CBD based on small bowel imaging, upper endoscopy, perianal assessment, and colonoscopy [8,9].…”