- 作者：Gert Van Assche ; Karin A. Herrmann ; Edouard Louis ; Simon M. Everett ; Jean-Fr茅d茅ric Colombel ; Jean-Fran莽ois Rahier ; Dirk Vanbeckevoort ; Paul Meunier ; Damian Tolan ; Olivier Ernst ; Paul Rutgeerts ; S茅verine Vermeire ; Isolde Aerden ; Aless ; ra Oortwijn ; Thomas Ochsenk眉hn
- 关键词：Crohn's disease ; Imaging ; Complications ; Anti-TNF therapy ; MR enteroclysis
- 刊名：Journal of Crohn's and Colitis
- 出版年：15 December, 2013
- 年：2013
- 卷：7
- 期：12
- 页码：950-957
- 全文大小：700 K
Background and aims
Anti TNF therapy induces mucosal healing in patients with Crohn's disease, but the effects on transmural inflammation in the ileum are not well understood. Magnetic resonance-enteroclysis (MRE) offers excellent imaging of transmural and peri-enteric lesions in Crohn's ileitis and we aimed to study its responsiveness to anti TNF therapy.Methods
In this multi-center prospective trial, anti TNF na茂ve patients with ileal Crohn's disease and with increased CRP and contrast enhanced wall thickening received infliximab 5 mg/kg at weeks 0, 2 and 6, and q8 weeks maintenance MRE was performed at baseline, 2 weeks and 6 months and assessed based on a predefined MRE score of severity in ileal Crohn's Disease.
Results
Twenty patients were included; of those, 18 patients underwent MRE at week 2 and 15 patients at weeks 2 and 26 as scheduled. Inflammatory components of the MRE index decreased by 鈮?#xA0;2 points and by 鈮?#xA0;50% at week 26 (primary endpoint) in 40% and 32% of patients (per protocol and intention to treat analysis, respectively). The MRE index improved in 44% at week 2 and in 80% at week 26. Complete absence of inflammatory lesions was observed in 0/18 at week 2 and 13% (2/15) at week 26. The obstructive elements did not change. Clinical and CRP improvement occurred as early as wk 2, but only CDAI correlated with the MRE index.
Conclusion
Improvement of MRE occurs from 2 weeks after infliximab therapy onwards and correlates with clinical response but normalization of MRE is rare.