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Observational Study
. 2020 Nov;8(9):1056-1066.
doi: 10.1177/2050640620947579. Epub 2020 Jul 28.

Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease

Iago Rodríguez-Lago  1   2 , Javier Del Hoyo  3   4 , Alexandre Pérez-Girbés  5 , Alejandro Garrido-Marín  3 , María José Casanova  4   6   7 , María Chaparro  4   6   7 , Agnès Fernández-Clotet  4   8 , Jesús Castro-Poceiro  8 , María José García  9 , Sara Sánchez  10 , Rocío Ferreiro-Iglesias  11 , Iria Bastón  11 , Marta Piqueras  12 , Lola Esteba I Bech de Careda  13 , Raquel Mena  12 , Cristina Suárez  14 , Joaquín Poza Cordón  14 , Alicia López-García  15 , Lucía Márquez  15 , Maite Arroyo  4   16 , Erika Alfambra  4   16 , Mónica Sierra  17 , Noelia Cano  17 , Pedro Delgado-Guillena  18 , Víctor Morales-Alvarado  18 , Juan Carlos Aparicio  19 , Iván Guerra  20 , Carolina Aulló  21 , Olga Merino  22 , Laura Arranz  23 , María Araceli Hidalgo  24 , Jordina Llaó  25 , Rocío Plaza  26 , Gema Molina  27 , Paola Torres  28 , Pablo Pérez-Galindo  29 , María Giselle Romero  30 , Claudia Herrera-deGuise  31 , Edisa Armesto  32 , Francisco Mesonero  33 , Santiago Frago-Larramona  34 , José Manuel Benítez  35   36 , Marta Calvo  37 , María Del Carmen López Martín  38 , Ainara Elorza  1   2 , Alejandro Larena  39 , Elena Peña  40 , María Del Carmen Rodríguez-Grau  41 , Jaime de Miguel-Criado  42 , Belén Botella  43 , José Antonio Olmos  44 , Laura López  45 , Urko Aguirre  46 , Javier P Gisbert  4   6   7 ; Young GETECCU Group
Affiliations
Observational Study

Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease

Iago Rodríguez-Lago et al. United European Gastroenterol J. 2020 Nov.

Abstract

Background: There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn's disease.

Aim: The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn's disease complicated with symptomatic strictures.

Methods: In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn's disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up.

Results: Overall, 262 patients with Crohn's disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab (N = 141, 54%) or adalimumab (N = 121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19-85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn's disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18-2.22; and HR 1.55, 95% CI 1.1-2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness.

Conclusions: Anti-TNF agents are effective in approximately a quarter of patients with Crohn's disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting.

Keywords: Anti-TNF; Crohn’s disease; biologic drug; stricture; surgery.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: IR-L has received financial support for travelling and educational activities from or has served as an advisory board member for MSD, Pfizer, Abbvie, Takeda, Janssen, Tillotts Pharma, Shire Pharmaceuticals, Ferring, Dr. Falk Pharma and Otsuka Pharmaceutical.

AP-G: has received financial support for travelling and educational activities from Rovi.

RF-I has served as a speaker for or has received research funding from Takeda, MSD, Abbvie, Janssen, Palex, Shire Pharmaceuticals, Tillotts Pharma and Casen Recordati.

MJC has received education funding from Pfizer, Janssen, MSD, Takeda, Ferring and Abbvie.

MC has served as a speaker or has received research or education funding from MSD, Abbvie, Hospira, Pfizer, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Dr. Falk Pharma, and Tillotts Pharma.

JPG has served as a speaker, consultant or advisory board member for or has received research funding from MSD, Abbvie, Hospira, Pfizer, Kern Pharma, Biogen, Takeda, Janssen, Roche, Sandoz, Celgene, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, and Vifor Pharma.

The remaining authors have no conflicts of interest related to this manuscript.

Figures

Figure 1.
Figure 1.
Main outcomes in patients receiving anti-TNF therapy, including anti-TNF drug survival, hospital admission, switch, surgery, use of new immunomodulators or endoscopic therapy.
Figure 2.
Figure 2.
Kaplan–Meier estimates of the effectiveness of anti-TNF therapy (a) and surgery rates (b) during follow-up.
See this image and copyright information in PMC

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