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.
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.
Baseline SWE values (21.
7 kPa, P=0.
022) and bowel wall thickness (8.
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
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.
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