Abstract
BackgroundIn recent years, the use of MRI in patients with Crohn’s disease (CD) has increased. However, few data are available on how MRI parameters of active disease change during treatment with anti-TNF and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. The aim of this study was to determine the changes over time in MRI parameters during treatment with anti-TNF in patients with CD, and to verify the correlation between MRI score, endoscopic appearance and clinical-biological markers.MethodsWe performed a prospective single centre study of 27 patients with active CD (18 males and 9 females; median age of 27,4 ys; age range, 19–49). All patients underwent ileocolonoscopy and MRI at baseline and 26 weeks after anti-TNF therapy. Endoscopic severity was graded according to the Simple Endoscopic Score for Crohn’s Disease (SES-CD) and Magnetic Resonance Index of Activity (MaRIA) was calculated. Patients underwent clinical evaluation (CDAI) and the C-reactive protein (CRP) level was measured. The associations between variables were assessed with Pearson’s bivariate correlation analysis.ResultsA total of 135 intestinal segments were studied. The median patient age was 27,4 years, 67 % were male and the mean disease duration was 6,1 years. For induction of remission, 18 patients were treated with infliximab and 9 with adalimumab. The mean SES-CD and MaRIA scores significantly changed at week 26 (SES-CD: 14,7 ± 8,9 at baseline vs. 4,4 ± 4,6 at 26 weeks - p < 0.001; MaRIA: 41,1 ± 14,8 at baseline vs. 32,8 ± 11,7 at 26 weeks - p < 0.001). Also the CDAI and serum levels of CRP decreased significantly following treatment (p < 0.001). The overall MaRIA correlated with endoscopic score and with clinical activity (CDAI) both at baseline and at week 26 (p < 0.05). The correlation between overall MaRIA and CRP was significant only at week 26 (p < 0.001).ConclusionsThe MaRIA has a good correlation with SES-CD, a high accuracy for prediction of endoscopic mucosal healing and is a reliable indicator to monitor the use of TNF antagonists in patients with CD.
Highlights
In recent years, the use of MRI in patients with Crohn’s disease (CD) has increased
The proinflammatory cytokine Tumor Necrosis Factor (TNF) alpha is a key mediator of inflammation associated with CD [3] and the recent development of antibody to TNF alpha drugs has led to significant improvements in the medical treatment of these patients [4, 5]
27 consecutive patients were included in the study for a total of 135 segments explored by ileocolonoscopy and evaluated by MRI
Summary
The use of MRI in patients with Crohn’s disease (CD) has increased. few data are available on how MRI parameters of active disease change during treatment with anti-TNF and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. The proinflammatory cytokine Tumor Necrosis Factor (TNF) alpha is a key mediator of inflammation associated with CD [3] and the recent development of antibody to TNF alpha (anti-TNF) drugs has led to significant improvements in the medical treatment of these patients [4, 5]. These antagonists of TNF-alpha, i.e. infliximab (IFX) and adalimumab (ADA), are effective in inducing as well as maintaining clinical remission in patients with moderatelyto-severely active CD disease who are refractory to traditional treatments (corticosteroids and immunosuppressive drugs). Complete disappearance of mucosal ulcerations is associated with favourable outcome, and after initiation with anti-TNF, mucosal healing (MH) leads to a decrease both in relapse rates and in disease related hospitalization, reducing the need for surgery [6]
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