Ultrasonography Tight Control and Monitoring in Crohn’s Disease During Different Biological Therapies: A Multicenter Study

Abstract

BACKGROUND & AIMS:Bowel ultrasonography (BUS) is a noninvasive tool for evaluating bowel activity in Crohn's disease (CD) patients. Aim of our multicenter study was to assess whether BUS helps to monitor intestinal activity improvement/resolution following different biological therapies. METHODS:Adult CD patients were prospectively enrolled at 16 sites in Italy. Changes in BUS parameters [i.e. bowel wall thickening (BWT), lesion length, echo pattern, blood flow changes and transmural healing (TH: normalization of all BUS parameters)] were analyzed at baseline and after 3, 6 and 12 months of different biological therapies. RESULTS:One hundred eighty-eight out of 201 CD patients were enrolled and analyzed (116 males [62%]; median age 36 years). Fifty-five percent of patients were treated with adalimumab, 16% with infliximab, 13% with vedolizumab and 16% with ustekinumab. TH rates at 12 months were 27.5% with an NNT of 3.6. TH at 12 months after adalimumab was 26.8%, 37% after infliximab, 27.2% after vedolizumab and 20% after ustekinumab. Mean BWT improvement from baseline was statistically significant at 3 and 12 months (P < .0001). Median Harvey-Bradshaw index, C-reactive protein and fecal calprotectin decreased after 12 months from baseline (P < .0001). Logistic regression analysis showed colonic lesion was associated with a higher risk of TH at 3 months and a greater BWT at baseline was associated with a lower risk of TH at 3 months [P [ .03 (OR 0.70, 95% CI 0.50-0.97)] and 12 months [P [ .01 (OR 0.58, 95% CI 0.38-0.89)]. At 3 months therapy optimization during the study was the only independent factor associated with a higher risk of no ultrasonographic response [P [ .02 (OR 3.34, 95% CI 1.18-9.47)] and at 12 months disease duration [P [ .02 (OR 3.03, 95% CI 1.15-7.94)]. CONCLUSIONS:Data indicate that BUS is useful to monitor biologics-induced bowel activity improvement/ resolution in CD.

Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease

“…IUS response to ustekinumab was detected as early as week 4, and a clinically meaningful percentage of patients achieved transmural healing, primarily in the colon, at week 16. Very recently, a multicenter Italian study assessed IUS to monitor CD activity in 188 patients receiving different biological therapies (adalimumab, infliximab, vedolizumab, and ustekinumab) [ 36 ]. IUS parameters of the study (bowel wall thickness, lesion length, bowel echo-pattern, vascularization, and transmural healing) were collected at baseline and after 3, 6, and 12 months of therapy.…”

Bowel Ultrasound in Inflammatory Bowel Disease: How Far in the Grayscale?

“…Beyond these indications, the role of BUS has been increasingly broadened in recent years from the evaluation of disease activity and its complications toward the monitoring of disease progression and treatment response both in CD and UC [ 53 , 54 ]. Recent data endorse the adoption of BUS in the tight monitoring of IBD patients due to its accuracy in assessing signs of response and TH [ 53 , 54 ]. Particularly in the management of CD, BUS can be incorporated as a “bridge” examination to colonoscopy, since the reduction of the BWT accurately predicts the endoscopic response [ 53 , 54 ].…”

“…Recent data endorse the adoption of BUS in the tight monitoring of IBD patients due to its accuracy in assessing signs of response and TH [ 53 , 54 ]. Particularly in the management of CD, BUS can be incorporated as a “bridge” examination to colonoscopy, since the reduction of the BWT accurately predicts the endoscopic response [ 53 , 54 ].…”

Cross-Sectional Imaging Instead of Colonoscopy in Inflammatory Bowel Diseases: Lights and Shadows

“…A decrease in BWT and a reduction in C-reactive protein (CRP) levels at three months were significantly correlated (p ≤ 0.001) [71]. Furthermore, an Italian multicenter study assessed the value of BUS for tight control and monitoring of CD patients treated with different biological therapies, including anti-TNF, ustekinumab and vedolizumab [72]. Modifications of BUS parameters were evaluated at baseline and after three, six and twelve months of treatment [72].…”

“…Furthermore, an Italian multicenter study assessed the value of BUS for tight control and monitoring of CD patients treated with different biological therapies, including anti-TNF, ustekinumab and vedolizumab [72]. Modifications of BUS parameters were evaluated at baseline and after three, six and twelve months of treatment [72]. BUS was shown able to individuate improvement and remission even after a few months from the start of biological therapies, and BUS-guided therapy escalation after three months led to lesion improvement in 41% of patients [72].…”