Published online Apr 14, 2019. doi: 10.3748/wjg.v25.i14.1764
Peer-review started: November 12, 2018
First decision: January 30, 2019
Revised: February 26, 2019
Accepted: March 1, 2019
Article in press: March 1, 2019
Published online: April 14, 2019
Identifying predictors of therapeutic response is the cornerstone of personalized medicine.
To identify predictors of long-term mucosal healing (MH) in patients with Crohn’s disease (CD) treated with tumor necrosis factor α (TNF-α) inhibitors.
Prospective single center study. Consecutive patients with clinically active CD requiring treatment with a TNF-α inhibitor were included. A baseline segmental CD Endoscopic Index of Severity (CDEIS) ≥ 10 in at least one segment or the presence of ulcerations were required for inclusion. Clinical, biological and endoscopic data were obtained at baseline, weeks 14 and 46. Endoscopic response (ER) was defined as a decrease ≥ 50% from baseline CDEIS and MH as partial CDEIS ≤ 5 in all segments.
Of 62 patients were included. At baseline, median CD Activity Index and CDEIS were 201 and 6.7, respectively with a significant reduction after one year of treatment (53 and 3.0 respectively, P < 0.001). At week 14, 56% of patients achieved ER and 34% MH. At week 46, the corresponding percentages were 52% and 44%. Baseline disease characteristics or biomarkers did not predict MH. A decrease from baseline CDEIS at week 14 of at least 80% was the best predictor of MH at week 46 (59% sensitivity and 91% specificity; area under the curve = 0.778).
Clinical and biomarker data are not useful predictors of response to TNF-α inhibitors in CD, whereas ER to induction therapy, defined as 80% reduction in global CDEIS, is a robust predictor of long-term MH. Achievement of this endoscopic endpoint may be considered as a therapeutic target for anti-TNF-α therapy.
Core tip: In our study we report that endoscopic response after completion of induction treatment with a tumor necrosis factor inhibitor predicts mucosal healing at long term in patients with Crohn’s disease, and that endoscopic evaluation at this time point may be considered in clinical practice to predict long term outcomes and could contribute to perform treatment adjustments.