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

Abstract

Background: The Lémann Index (LI) was recently developed to evaluate the cumulative bowel damage in patients with Crohn’s disease (CD).

Aims: To search for a difference between adalimumab and azathioprine to halt the progression of bowel damage in active CD, using the LI.

Methods: A single-centre, retrospective study was conducted. Patients with CD 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 LI 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 = .0006). The LI 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 CD while that with azathioprine does not.

Keywords:

• Anti-TNF
• colonoscopy
• magnetic resonance enterography
• small intestine
• thiopurine

Acknowledgements

The authors thank Dr. Giorgia Bodini and Dr. Costanza De Maria for providing the database to calculate the Lémann Index. The authors also thank Dr. Elena Mosso for having followed the approval process of the study by the ethics committee.

Disclosure statement

The authors report no conflicts of interest.