Early Transmural Response Assessed Using Magnetic Resonance Imaging Could Predict Sustained Clinical Remission and Prevent Bowel Damage in Patients with Crohn's Disease Treated with Anti-Tumour Necrosis Factor Therapy

J Crohns Colitis. 2020 Nov 7;14(11):1524-1534. doi: 10.1093/ecco-jcc/jjaa098.

Abstract

Background: Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn's disease [CD].

Aims: We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage.

Methods: All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn's Disease Activity Index < 150, C-reactive protein < 5 mg/L and faecal calprotectin < 250 µg/g, with no switch of anti-TNF agents, no bowel resection and no therapeutic intensification between W12 and W52.

Results: Among 46 patients, 22 [47.8%] achieved CFREM at W52. Anti-TNF agents were able to heal almost all CD lesions as soon as W12 [p < 0.05]. Early transmural response defined as a 25% decrease of either Clermont score (odds ratio [OR] = 7.7 [1.7-34.0], p < 0.001) or Magnetic Resonance Index of Activity (OR = 4.2 [1.3-13.3], p = 0.015) was predictive of CFREM at W52. Achieving at least two items on W12-MRI among ulceration healing, disappearance of enlarged lymph nodes or sclerolipomatosis, ΔADC [apparent diffusion coefficient] > +10% or ΔRCE [relative contrast enhancement] > -30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0-0.9]; p = 0.037).

Conclusion: Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD.

Keywords: Crohn’s disease; Clermont score; MRI; MaRIA; transmural healing; transmural response.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adalimumab* / administration & dosage
  • Adalimumab* / adverse effects
  • Adult
  • Biomarkers, Pharmacological / analysis
  • C-Reactive Protein / analysis
  • Crohn Disease* / diagnosis
  • Crohn Disease* / drug therapy
  • Crohn Disease* / epidemiology
  • Crohn Disease* / physiopathology
  • Feasibility Studies
  • Female
  • France / epidemiology
  • Humans
  • Infliximab* / administration & dosage
  • Infliximab* / adverse effects
  • Intestinal Mucosa* / diagnostic imaging
  • Intestinal Mucosa* / pathology
  • Leukocyte L1 Antigen Complex / analysis
  • Magnetic Resonance Imaging / methods*
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Remission Induction / methods
  • Severity of Illness Index
  • Tumor Necrosis Factor Inhibitors / administration & dosage
  • Tumor Necrosis Factor Inhibitors / adverse effects

Substances

  • Biomarkers, Pharmacological
  • Leukocyte L1 Antigen Complex
  • Tumor Necrosis Factor Inhibitors
  • C-Reactive Protein
  • Infliximab
  • Adalimumab