Mucosal healing at 3 months predicts long-term endoscopic remission in anti-TNF-treated luminal Crohn's disease

Abstract

Background and aims. Studies performed on patient and disease characteristics predicting the treatment response in tumor necrosis factor alpha antibody (anti-TNF)-treated Crohn's disease (CD) have generally been based on clinical data. Only a few studies have assessed the role of endoscopy as a predictor for long-term response for anti-TNF therapy. Our aim was to evaluate the role of early endoscopy in predicting the long-term endoscopic response to anti-TNF in active luminal CD in a clinical setting. Patients and methods. Forty-two patients with active luminal CD, treated for at least 3 months with anti-TNF, either adalimumab (52%) or infliximab (48%), were included in this prospective study. Data on the simple endoscopic score for Crohn's disease (SES-CD) at 3 months after therapy commencement, and either data on the SES-CD or surgery after 1 year, were available for all patients. Endoscopic remission was defined as SES-CD 0−2. Results. At 3 months after commencing anti-TNF therapy, 10 patients (24%) were in endoscopic remission. Thirty-three patients continued anti-TNF as maintenance therapy. At 1 year, endoscopic remission (11/33, 33%) was significantly more common in those patients who had been in endoscopic remission at 3 months, compared with those with endoscopically active disease at 3 months (7/10, 70% vs. 4/23, 17%, p = 0.01). The 3-month SES-CD had a sensitivity of 88%, and specificity of 64%, to predict 1-year endoscopic remission in patients who received anti-TNF maintenance therapy. Conclusions. In anti-TNF-treated active luminal CD mucosal healing at 3 months is a strong predictor for long-term endoscopic response.

Key Words::

• adalimumab
• calprotectin
• CDAI
• IBD
• infliximab
• SES-CD

Acknowledgements

We thank study nurse Pirkko Tuukkala for technical assistance. The study was supported by unrestricted grants from the Medical Society of Finland, the Finnish Foundation for Gastroenterological Research, and MSD Finland. Statement of authorship: CGB designed the study, carried out the studies and data analyses, performed the statistical analyses, and drafted and finished the manuscript. UN designed the study, carried out the studies, and helped to draft the manuscript. TS designed the study, carried out the studies, and helped to draft the manuscript. UT participated in the design of the study and carried out the studies. PA participated in the design of the study, carried out the studies, and helped to draft the manuscript. MF designed and supervised the study, carried out the studies, and helped to draft the manuscript. All authors read and approved the final manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.