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

Davide Giuseppe Ribaldone, Gian Paolo Caviglia, Rinaldo Pellicano, Marta Vernero, Andrea Italia, Mario Morino, Giorgio Maria Saracco, Marco Astegiano

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalScandinavian Journal of Gastroenterology
DOIs
Publication statusAccepted/In press - Jan 1 2019
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Gastroenterology

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    Ribaldone, D. G., Caviglia, G. P., Pellicano, R., Vernero, M., Italia, A., Morino, M., Saracco, G. M., & Astegiano, M. (Accepted/In press). Adalimumab versus azathioprine to halt the progression of bowel damage in Crohn’s disease: application of Lémann Index. Scandinavian Journal of Gastroenterology. https://doi.org/10.1080/00365521.2019.1686057