Anti-tumor necrosis factor (TNF)-α drugs, such as infliximab, are widely used to treat CD patients, especially those with frequent relapses, severe disease activity, and poor prognosis
.
However, up to 40% of patients do not respond to anti-TNF-α drugs, and about 10% have adverse drug reactions that interfere with treatment
.
Therefore, predicting and monitoring response to anti-TNF-α therapy is crucial in the era of "tight control" and "prescribed medicine" strategies
.
There are several findings that suggest that C-reactive protein, fecal calprotectin, mucosal changes, and transmural lesions assessed by cross-sectional imaging are associated with treatment outcomes in CD patients receiving antineoplastic drugs
.
Endoscopy is the gold standard for evaluating the efficacy of CD patients within 3-6 months of treatment with antineoplastic drugs
.
Given that frequent endoscopic assessments during short-term follow-up are not feasible due to their invasiveness, there is a clinical need for an alternative objective, easily reproducible, but noninvasive assessment method
.
.
As a cross-sectional imaging modality for CD, bowel ultrasonography has been recommended and has been widely used to assess changes in the bowel in CD
.
Previous studies have demonstrated that shear wave elastography (SWE) is a feasible and accurate ultrasound elastography modality for noninvasive quantitative analysis of intestinal fibrosis in CD patients
.
The degree of fibrosis has been reported to affect the therapeutic effect of antitumor drugs
.
Therefore, SWE may help predict early response to anti-TNF therapy and may be an indicator of improvement in intestinal fibrosis
.
Therefore, this study aimed to investigate (a) changes in intestinal behavior in CD patients receiving anti-TNF therapy by ultrasound; (b) the feasibility of shear wave elastography (SWE) in predicting early response to anti-TNF therapy
.
We included patients with ileal or ileocolonic CD who received anti-TNF therapy
.
All patients underwent bowel ultrasonography at baseline and at weeks 2, 6, and 14
.
Changes in bowel wall thickness, bowel wall Doppler signal (Limberg score), and SWE values were compared using linear mixed models
.
The primary outcome measure was early response to anti-TNF therapy and was based on clinical and colonoscopy findings at Week 14
.
Twenty of the 30 patients included in this study responded to anti-TNF therapy at week 14
.
Compared with the non-responder group, the intestinal wall thickness and SWE value of the responder group showed a significant downward trend (P = 0.
003)
.
Compared with baseline, bowel wall thickness, Limberg score, and SWE values were significantly lower in the responder group as early as week 2 (P < 0.
001)
.
Baseline SWE values (21.
3±8.
7 vs.
15.
3±4.
7 kPa, P=0.
022) and bowel wall thickness (8.
5±2.
3 vs.
6.
9±1.
5 mm, P=0.
027) were significantly higher in the non-responder group than in the responder group
.
Figure: B-ultrasound showing intestinal lesions
This study conclusively demonstrated that changes in intestinal ultrasound behavior can be assessed as early as 2 weeks after initiation of anti-TNF therapy, and that early response to anti-TNF therapy can be predicted by intestinal ultrasound and elastography
.
.
Original source:
Yu-Jun Chen.
Et al.
Longitudinal Bowel Behavior Assessed by Bowel Ultrasound to Predict Early Response to Anti-TNF Therapy in Patients with Crohn's Disease: A Pilot Study.
Inflammatory Bowel Diseases.
2021.
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