Ultrasonographic Changes at 12 Weeks of Anti-TNF Drugs Predict 1-year Sonographic Response and Clinical Outcome in Crohn's Disease: A Multicenter Study
Por:
Ripollés T, Paredes JM, Martínez-Pérez MJ, Rimola J, Jauregui-Amezaga A, Bouzas R, Martin G and Moreno-Osset E
Publicada:
1 oct 2016
Ahead of Print:
30 ago 2016
Resumen:
Background:The objective was to assess the long-term effect of
biological treatment on transmural lesions of Crohn's disease evaluated
with ultrasound, including contrast-enhanced
ultrasound.Methods:Fifty-one patients with active Crohn's disease were
included in a prospective multicenter longitudinal study. All patients
underwent a clinical assessment and sonographic examination at baseline,
12 weeks after treatment initiation, and after 1-year of treatment.
Patients were clinically followed at least 2 years from inclusion until
the end of the study. Ultrasonographic evaluation included bowel wall
thickness, color Doppler grade, parietal enhancement, and presence of
transmural complications or stenosis. Sonographic changes after
treatment were classified as normalization, improvement, or lack of
response.Results:Improvement at 52 weeks was more frequent in patients
with improvement at final of induction (12 weeks) compared with patients
who did not improve (85% versus 28%; P < 0.0001). One-year sonographic
evolution correlated with clinical response; 28 of the 29 (96.5%)
patients with sonographic improvement at 52 weeks showed clinical
remission or response. Patients without sonographic improvement at 52
weeks of treatment were more likely to have a change or intensification
in medication or surgery (13/20, 65%) during the next year of follow-up
than patients with improvement on the sonography (3/28, 11%).
Stricturing behavior was the only sonographic feature associated to a
negative predictive value of response (P =
0.0001).Conclusions:Sonographic response after 12 weeks of therapy is
more pronounced and predicts 1-year sonographic response. Sonographic
response at 1-year examination correlates with 1-year clinical response
and is a predictor of further treatment's efficacy, 1-year or longer
period of follow-up.
Filiaciones:
:
Departments of *Radiology, and †Gastroenterology, Hospital Universitario Dr Peset, Valencia, Spain
Departments of ‡Radiology, Hospital Clinic Barcelona, and §Gastroenterology, Hospital Clinic Barcelona, Spain
and ?Department of Radiology, Complejo Hospitalario Universitario Vigo, Spain
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