Efficacy of tumour necrosis factor antagonists in stricturing Crohn's disease: A tertiary center real-life experience

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Abstract

Background Stenosis is the most common complication of Crohn's disease (CD). Long-term outcome of patients receiving tumour necrosis factor (TNF) antagonists for such disease complication is poorly understood. Methods 51 CD patients (from July 2006 to November 2015) who had a diagnosis of small bowel or colonic stenosis, diagnosed by colonoscopy and/or MRI enterography, and were treated with TNF antagonists (adalimumab or infliximab) were enrolled. The primary outcome was to assess the rate of success of TNF antagonists on avoiding abdominal surgery for stricturing CD patients. Results 20 patients (39.2%) underwent surgery during the follow-up period. The overall incidence of abdominal surgery was 1.8 per 100 person-months at risk, while the median time to surgery was 37.9 months. The univariable and multivariable Cox's proportional hazards analysis of baseline parameters indicated that disease location (colonic vs ileal, HR: 28.2, 95% CI: 2.45–324, p = 0.007; ileocolonic vs ileal, HR: 3.38, 95% CI: 1.09–10.5, p = 0.035), prestenotic dilatation (per 1-mm increase, HR: 1.08, 95% CI: 1.01–1.15, p = 0.022) and the existence of non-perianal fistula (HR: 9.77, 95% CI: 2.99–31.9, p < 0.001) are independent risk factors for abdominal surgery. Conclusions In stricturing CD, anti-TNFs are effective in up to about two-thirds of the patients.

Original languageEnglish
Pages (from-to)872-877
Number of pages6
JournalDigestive and Liver Disease
Volume49
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

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Crohn Disease
Tumor Necrosis Factor-alpha
Pathologic Constriction
Colonic Diseases
Colonoscopy
Fistula
Dilatation
Incidence

Keywords

  • Adalimumab
  • Anti-TNF
  • Crohn's disease
  • Fistulae
  • Infliximab
  • Stenosis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{dacaee6d21ae46d28df51955d51ca717,
title = "Efficacy of tumour necrosis factor antagonists in stricturing Crohn's disease: A tertiary center real-life experience",
abstract = "Background Stenosis is the most common complication of Crohn's disease (CD). Long-term outcome of patients receiving tumour necrosis factor (TNF) antagonists for such disease complication is poorly understood. Methods 51 CD patients (from July 2006 to November 2015) who had a diagnosis of small bowel or colonic stenosis, diagnosed by colonoscopy and/or MRI enterography, and were treated with TNF antagonists (adalimumab or infliximab) were enrolled. The primary outcome was to assess the rate of success of TNF antagonists on avoiding abdominal surgery for stricturing CD patients. Results 20 patients (39.2{\%}) underwent surgery during the follow-up period. The overall incidence of abdominal surgery was 1.8 per 100 person-months at risk, while the median time to surgery was 37.9 months. The univariable and multivariable Cox's proportional hazards analysis of baseline parameters indicated that disease location (colonic vs ileal, HR: 28.2, 95{\%} CI: 2.45–324, p = 0.007; ileocolonic vs ileal, HR: 3.38, 95{\%} CI: 1.09–10.5, p = 0.035), prestenotic dilatation (per 1-mm increase, HR: 1.08, 95{\%} CI: 1.01–1.15, p = 0.022) and the existence of non-perianal fistula (HR: 9.77, 95{\%} CI: 2.99–31.9, p < 0.001) are independent risk factors for abdominal surgery. Conclusions In stricturing CD, anti-TNFs are effective in up to about two-thirds of the patients.",
keywords = "Adalimumab, Anti-TNF, Crohn's disease, Fistulae, Infliximab, Stenosis",
author = "Mariangela Allocca and Cristiana Bonifacio and Gionata Fiorino and Antonino Spinelli and Federica Furfaro and Luca Balzarini and Stefanos Bonovas and Silvio Danese",
year = "2017",
month = "8",
day = "1",
doi = "10.1016/j.dld.2017.03.012",
language = "English",
volume = "49",
pages = "872--877",
journal = "Digestive and Liver Disease",
issn = "1590-8658",
publisher = "Elsevier B.V.",
number = "8",

}

TY - JOUR

T1 - Efficacy of tumour necrosis factor antagonists in stricturing Crohn's disease

T2 - A tertiary center real-life experience

AU - Allocca, Mariangela

AU - Bonifacio, Cristiana

AU - Fiorino, Gionata

AU - Spinelli, Antonino

AU - Furfaro, Federica

AU - Balzarini, Luca

AU - Bonovas, Stefanos

AU - Danese, Silvio

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background Stenosis is the most common complication of Crohn's disease (CD). Long-term outcome of patients receiving tumour necrosis factor (TNF) antagonists for such disease complication is poorly understood. Methods 51 CD patients (from July 2006 to November 2015) who had a diagnosis of small bowel or colonic stenosis, diagnosed by colonoscopy and/or MRI enterography, and were treated with TNF antagonists (adalimumab or infliximab) were enrolled. The primary outcome was to assess the rate of success of TNF antagonists on avoiding abdominal surgery for stricturing CD patients. Results 20 patients (39.2%) underwent surgery during the follow-up period. The overall incidence of abdominal surgery was 1.8 per 100 person-months at risk, while the median time to surgery was 37.9 months. The univariable and multivariable Cox's proportional hazards analysis of baseline parameters indicated that disease location (colonic vs ileal, HR: 28.2, 95% CI: 2.45–324, p = 0.007; ileocolonic vs ileal, HR: 3.38, 95% CI: 1.09–10.5, p = 0.035), prestenotic dilatation (per 1-mm increase, HR: 1.08, 95% CI: 1.01–1.15, p = 0.022) and the existence of non-perianal fistula (HR: 9.77, 95% CI: 2.99–31.9, p < 0.001) are independent risk factors for abdominal surgery. Conclusions In stricturing CD, anti-TNFs are effective in up to about two-thirds of the patients.

AB - Background Stenosis is the most common complication of Crohn's disease (CD). Long-term outcome of patients receiving tumour necrosis factor (TNF) antagonists for such disease complication is poorly understood. Methods 51 CD patients (from July 2006 to November 2015) who had a diagnosis of small bowel or colonic stenosis, diagnosed by colonoscopy and/or MRI enterography, and were treated with TNF antagonists (adalimumab or infliximab) were enrolled. The primary outcome was to assess the rate of success of TNF antagonists on avoiding abdominal surgery for stricturing CD patients. Results 20 patients (39.2%) underwent surgery during the follow-up period. The overall incidence of abdominal surgery was 1.8 per 100 person-months at risk, while the median time to surgery was 37.9 months. The univariable and multivariable Cox's proportional hazards analysis of baseline parameters indicated that disease location (colonic vs ileal, HR: 28.2, 95% CI: 2.45–324, p = 0.007; ileocolonic vs ileal, HR: 3.38, 95% CI: 1.09–10.5, p = 0.035), prestenotic dilatation (per 1-mm increase, HR: 1.08, 95% CI: 1.01–1.15, p = 0.022) and the existence of non-perianal fistula (HR: 9.77, 95% CI: 2.99–31.9, p < 0.001) are independent risk factors for abdominal surgery. Conclusions In stricturing CD, anti-TNFs are effective in up to about two-thirds of the patients.

KW - Adalimumab

KW - Anti-TNF

KW - Crohn's disease

KW - Fistulae

KW - Infliximab

KW - Stenosis

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U2 - 10.1016/j.dld.2017.03.012

DO - 10.1016/j.dld.2017.03.012

M3 - Article

AN - SCOPUS:85017444826

VL - 49

SP - 872

EP - 877

JO - Digestive and Liver Disease

JF - Digestive and Liver Disease

SN - 1590-8658

IS - 8

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