Advertisement

Is there a role of magnetic resonance imaging in deciding to stop anti-tumor necrosis factor treatment in ileal Crohn's disease?

      Highlights

      • MRE helps to identify subgroups of patient candidates to discontinuation of anti-TNF.
      • Silent activity detected by MRE increases more than twofold the risk of relapse.
      • MRE scores are more useful than single MR parameters to predict the relapse.

      Abstract

      Purpose

      This study was performed to assess the ability of magnetic resonance enterography to predict the evolution of patients in whom anti-tumor necrosis factor-α therapy was suspended.

      Methods

      A prospective study of patients with ileal Crohn's disease was performed.

      Results

      Twenty-nine patients were included. Patients who later relapsed showed higher magnetic resonance scores than those who did not relapse (4.2 vs. 2.5, respectively; p < 0.02). The area under the receiving-operating characteristics curve was 0.755 when discriminating patients who relapsed.

      Conclusions

      Magnetic resonance enterography should be taken into account when deciding the withdrawal of anti-tumor necrosis factor-α in patients with Crohn's disease.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Louis E.
        • Collard A.
        • Oger A.F.
        • Degroote E.
        • Aboul Nasr El Yafi F.A.
        • Belaiche J.
        Behaviour of Crohn's disease according to the Vienna classification: changing pattern over the course of the disease.
        Gut. 2001; 49: 777-782
        • Peyrin-Biroulet L.
        • Deltenre P.
        • de Suray N.
        • Branche J.
        • Sandborn W.J.
        • Colombel J.F.
        Efficacy and safety of tumor necrosis factor antagonists in Crohn's disease: meta-analysis of placebo-controlled trials.
        Clin Gastroenterol Hepatol. 2008; 6: 644-653
        • Lichtenstein G.R.
        • Hanauer S.B.
        • Sandborn W.J.
        Management of Crohn's disease in adults.
        Am J Gastroenterol. 2009; 104: 465-483
        • Fellermann K.
        Adverse events of tumor necrosis factor inhibitors.
        Dig Dis. 2013; 31: 374-378
        • Panes J.
        • Bouhnik Y.
        • Reinish W.
        • Stoker J.
        • Taylor S.A.
        • Baumgart D.C.
        • et al.
        Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-base consensus guidelines.
        J Crohns Colitis. 2013; 7: 556-585
        • Pittet V.
        • Froehlich F.
        • Maillard M.H.
        • Mottet C.
        • Gonvers J.-J.
        • Felley C.
        • et al.
        When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel.
        J Crohns Colitis. 2013; 7: 820-826
        • Gallego J.C.
        • Echarri A.
        • Porta A.
        • Ollero V.
        Ileal Crohn's disease: MRI with endoscopic correlation.
        Eur J Radiol. 2011; 80: e8-e12
        • Rimola J.
        • Rodriguez S.
        • García-Bosch O.
        • Ordás I.
        • Ayala E.
        • Aceituno M.
        • et al.
        Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease.
        Gut. 2009; 58: 1113-1120
        • Louis E.
        • Mary J.Y.
        • Vernier-Massouille G.
        • Grimaud J.C.
        • Bouhnik Y.
        • Laharie D.
        • et al.
        Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped.
        Gastroenterology. 2012; 142: 63-70
        • Echarri A.
        • Ollero V.
        • Gallego J.C.
        • Rodríguez J.A.
        • Castro J.
        P403 predictors of relapse after discontinuing anti-TNF therapy in Crohn's disease patients on deep remission.
        J Crohns Colitis. 2013; 7: S171
        • Molnár T.
        • Lakatos P.L.
        • Farkas K.
        • Nagy F.
        • Szepes Z.
        • Miheller P.
        • et al.
        Predictors of relapse in patients with Crohn's disease in remission after 1 year of biological therapy.
        Aliment Pharmacol Ther. 2013; 37: 225-233
        • Papamichael K.
        • Vande Casteele N.
        • Gils A.
        • Tops S.
        • Hauesnstein S.
        • Singh S.
        • et al.
        Long-term outcome of patients with Crohn's disease who discontinued infliximab therapy upon clinical remission.
        Clin Gastroenterol Hepatol. 2015; 13: 1103-1110
        • Waugh A.W.
        • Garg S.
        • Matic K.
        • Gramlich L.
        • Wong C.
        • Sadowski D.C.
        • et al.
        Maintenance of clinical benefit in Crohn's disease patients after discontinuation of infliximab: long-term follow-up of a single centre cohort.
        Aliment Pharmacol Ther. 2010; 32: 1129-1134
        • Molander P.
        • Färkkilä M.
        • Salminen K.
        • Kemppainen H.
        • Blomster T.
        • Koskela R.
        • et al.
        Outcome after discontinuation of TNF α-blocking therapy in patients with inflammatory bowel disease in deep remission.
        Inflamm Bowel Dis. 2014; 20: 1021-1028
        • Gisbert J.P.
        • Marín A.C.
        • Chaparro M.
        Systematic review: factors associated with relapse of inflammatory bowel disease after discontinuation of anti-TNF therapy.
        Aliment Pharmacol Ther. 2015; 42: 391-405
        • Gecse K.B.
        • Brandse J.F.
        • van Wilpe S.
        • Löwenberg M.
        • Ponsioen C.
        • van den Brink G.
        • et al.
        Impact of disease location on fecal calprotectin levels in Crohn's disease.
        Scand J Gastroenterol. 2015; 50: 841-847
        • Annunziata M.L.
        • Paparella L.G.
        • Sansoni I.
        • Ballestrieri P.
        • Cicala M.
        Normalized wall thickness at MRE predicts remission in Crohn's disease after infliximab discontinuation: a 5 years follow-up.
        J Crohns Colitis. 2014; 8: S233
        • Van Assche G.
        • Herrmann K.A.
        • Louis E.
        • Everett S.M.
        • Colombel J.-F.
        • Rahier J.-F.
        • et al.
        Effects of infliximab therapy on transmural lesions as assessed by magnetic resonance enteroclysis in patients with Crohn's disease.
        J Crohns Colitis. 2013; 7: 950-957
        • Fujii
        Advancing magnetic resonance imaging in Crohn's disease.
        Digestion. 2014; 89: 24-30
        • Deepak P.
        • Fletcher J.G.
        • Fidler J.L.
        • Barlow J.M.
        • Sheedy S.P.
        • Kolbe A.B.
        Radiological response is associated with better long-term outcomes and is a potential treatment target in patients with small bowel Crohn's disease.
        Am J Gastroenterol. 2016; 111: 997-1006