{"title":"Inadequate Efficacy of Biologics for Treating Proximal Ileal Lesions in Crohn's Disease; a prospective multicenter study.","authors":"Kento Takenaka, Tadakazu Hisamatsu, Taku Kobayashi, Hironori Yamamoto, Naoki Ohmiya, Ryohei Hayashi, Katsuyoshi Matsuoka, Masayuki Saruta, Akira Andoh, Norimasa Fukata, Kenji Watanabe, Hiroyuki Imaeda, Fumihito Hirai, Takayuki Matsumoto, Akihiro Hirakawa, Tomonori Yano, Minoru Matsuura, Ryuichi Okamoto, Kazuo Ohtsuka, Mamoru Watanabe","doi":"10.1016/j.cgh.2024.10.030","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>While biologic therapy has revolutionized the treatment of Crohn's disease (CD), surgery remains unavoidable in cases involving ileal complications. We aimed to evaluate the efficacy of biologics on proximal ileal lesions using balloon-assisted enteroscopy (BAE).</p><p><strong>Methods: </strong>This open-label multicenter prospective study was conducted at tertiary referral centers in Japan. We enrolled 253 patients with active ileal CD who were treated with biologics (infliximab/adalimumab/ustekinumab/vedolizumab). BAE was performed at week 0 and week 26, and endoscopic findings were centrally assessed. We evaluated the rate of endoscopic remission (defined as having a maximum mSES-CD <4) at week 26 and patient prognosis (CD-related hospitalization and surgery).</p><p><strong>Results: </strong>At baseline, 74 (29.2%) patients had proximal ileal ulcerations without terminal ileal ulcerations. The second BAE showed that endoscopic remission was achieved in 91 (36.0%) patients. Of the patients with complete ulcer healing of the terminal ileum, 28.6% (22/77) had residual ulcers in the proximal ileum. The rate of endoscopic remission in the proximal ileum (50.9%) was relatively lower compared to the colon (63.4%) and terminal ileum (56.7%), a trend consistently observed across all treatment agents. After a median follow-up of 134 weeks, residual ulcerations in the proximal ileum were associated with a poorer prognosis (P=0.0126 for hospitalization and P=0.0014 for surgery).</p><p><strong>Conclusions: </strong>A substantial proportion of patients with CD exhibited ulcerations in the proximal ileum which correlated with a poorer prognosis. These lesions proved challenging to heal, regardless of the type of biologic used.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cgh.2024.10.030","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aims: While biologic therapy has revolutionized the treatment of Crohn's disease (CD), surgery remains unavoidable in cases involving ileal complications. We aimed to evaluate the efficacy of biologics on proximal ileal lesions using balloon-assisted enteroscopy (BAE).
Methods: This open-label multicenter prospective study was conducted at tertiary referral centers in Japan. We enrolled 253 patients with active ileal CD who were treated with biologics (infliximab/adalimumab/ustekinumab/vedolizumab). BAE was performed at week 0 and week 26, and endoscopic findings were centrally assessed. We evaluated the rate of endoscopic remission (defined as having a maximum mSES-CD <4) at week 26 and patient prognosis (CD-related hospitalization and surgery).
Results: At baseline, 74 (29.2%) patients had proximal ileal ulcerations without terminal ileal ulcerations. The second BAE showed that endoscopic remission was achieved in 91 (36.0%) patients. Of the patients with complete ulcer healing of the terminal ileum, 28.6% (22/77) had residual ulcers in the proximal ileum. The rate of endoscopic remission in the proximal ileum (50.9%) was relatively lower compared to the colon (63.4%) and terminal ileum (56.7%), a trend consistently observed across all treatment agents. After a median follow-up of 134 weeks, residual ulcerations in the proximal ileum were associated with a poorer prognosis (P=0.0126 for hospitalization and P=0.0014 for surgery).
Conclusions: A substantial proportion of patients with CD exhibited ulcerations in the proximal ileum which correlated with a poorer prognosis. These lesions proved challenging to heal, regardless of the type of biologic used.
期刊介绍:
Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion.
As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.