Updated: Jan 29, 2021
Pre‐treatment magnetic resonance enterography findings predict the response to TNF‐alpha inhibitors in Crohn's disease
Identifying predictors of therapeutic response is the cornerstone of personalised medicine.
To identify predictors of long‐term healing of severe inflammatory lesions based on magnetic resonance enterography (MRE) findings in patients with Crohn’s disease (CD) treated with tumour necrosis factor alpha (TNF‐α) inhibitors.
This prospective longitudinal single‐centre study included patients with clinically active CD requiring treatment with TNF‐α inhibitors with at least one intestinal segment with a severe inflammatory lesion detected by MRE (segmental MaRIA ≥11). MRE data were obtained at baseline, and at weeks 14 and 46. The primary endpoint was healing of severe inflammatory lesions (MaRIA <11) in each segment. The secondary endpoint was healing of all severe inflammatory lesions on a per‐patient analysis.
We included 58 patients with 86 intestinal segments with severe inflammatory lesions. At week 46, healing of severe lesions was found in 51/86 (59.3%) segments, and complete healing of inflammatory lesions in all segments was found in 28/58 (48.6%) patients. Multivariable analysis found baseline‐negative predictors of long‐term healing of severe inflammation were ileal (as opposed to colonic) location (OR 0.00, [0.00‐0.56] P = 0.002) and presence of creeping fat on MRE (OR 0.00 [0.00‐0.57]; P = 0.001). Persistence of segmental MaRIA score >10.6 at week 14 was a negative predictor of healing at week 46 (OR 0.3 [0.04‐‐0.38]; P < 0.001).
In patients with CD, the absence of creeping fat detected at baseline MRE and location of severe inflammatory lesions are clinically relevant predictors of long‐term healing of severe inflammation under treatment with TNF‐α inhibitors.