Early treatment with anti‐tumor necrosis factor agents improves long‐term effectiveness in symptomatic stricturing Crohn’s disease
Authors: Rodríguez‐Lago Iago , Del Hoyo Javier , Pérez‐Girbés Alexandre , Garrido‐Marín Alejandro , Casanova María José , Chaparro María , Fernández‐Clotet Agnès , Castro‐Poceiro Jesús , García María José , Sánchez Sara , Ferreiro‐Iglesias Rocío , Bastón Iria , Piqueras Marta ,   Lola Esteba i Bech de Careda, Mena Raquel , Suárez Cristina , Cordón Joaquín Poza , López‐García Alicia , Márquez Lucía , Arroyo Maite , Alfambra Erika , Sierra Mónica , Cano Noelia , Delgado‐Guillena Pedro , Morales‐Alvarado Víctor , Aparicio Juan Carlos , Guerra Iván , Aulló Carolina , Merino Olga , Arranz Laura , Hidalgo María Araceli , Llaó Jordina , Plaza Rocío , Molina Gema , Torres Paola , Pérez‐Galindo Pablo , Romero María Giselle , Herrera‐deGuise Claudia , Armesto Edisa , Mesonero Francisco , Frago‐Larramona Santiago , Benítez José Manuel , Calvo Marta , Martín Carmen López , Elorza Ainara , Larena Alejandro , Peña Elena , Rodríguez‐Grau María del Carmen , Miguel‐Criado Jaime de , Botella Belén , Olmos José Antonio , López Laura , Aguirre Urko , Gisbert Javier P. ,   Young GETECCU Group
Published: July 2020

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.