Ultrasonographic parameters associated with mucosal healing 1 year after infliximab therapy in Crohn's Disease: a multicentric and prospective study
Journal of Crohn's and Colitis(2022)
摘要
Abstract Background Bowel wall thickness (BWT) is an accurate ultrasonographic parameter to assess disease activity in Crohn’s disease (CD). The IBUS-SAS score includes BWT, doppler sign, loss of stratification and inflammatory fat (i-fat) and allows a reproducible assessment of inflammation in CD using intestinal ultrasound (IUS). Our aim: to assess clinical, laboratorial and ultrasonographic predictors of mucosal healing (MH) at 1 year of infliximab (IFX) therapy. Methods Prospective multicentric cohort study including patients with active CD starting IFX. Harvey-Bradshaw index, C-reactive protein (CRP), fecal calprotectin (FC) and IUS were performed at week 0, 14, 30 and 54. IUS remission was defined as BWT normalization (≤3mm) in the most affected segment. Ileocolonoscopy was performed at W0 and W54. MH was defined as SES-CD <3 with no ulcers. Results We included 28 patients with CD (61% male; mean age of 34±12y). Clinical, laboratory and sonographic parameters are shown in Table 1. At week 54, 89% were in clinical remission, 79% had normalization of CRP and FC, 50% had IUS remission and 39% had MH. MH at W54 was associated with lower BWT at W14 (3.7 vs 5.2mm, p=0.049), lower Limberg score at W14 (1 vs 2, p=0.006), lower levels of i-fat at W14 (18 vs 72%, p=0.006) and lower IBUS-SAS score at W0, W14 and W30 (47 vs 71, p=0.002; 26 vs 58, p=0.001; 25 vs 50 p=0.046). We found a fair to good correlation between SES-CD W54 and BWT at W14 (r=0.45, p=0.015), Limberg score at W14 (r=0.4, p=0.037), IBUS-SAS at W0 and W14 (r=0.49, p=0.008; r=0.58, p=0.001). The area under the curve of IBUS-SAS for MH was 0.86 at W0 and W14 and 0.69 at W30. Best IBUS-SAS cut-off value was 27.6 at W14. Conclusion Lower values of BWT, Limberg score and i-fat after induction (W14) were associated with MH at 1 year of therapy. IBUS-SAS score at W14 had the highest AUC to predict MH at 1 year. Early IUS monitoring can be a helpful tool to predict response to therapy in CD patients at 1 year.
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