Crohn's Disease Stricture Response to Treatment Assessed with Magnetic Resonance Imaging and Intestinal Ultrasound: STRIDENT Randomized Trial.

IF 4.5 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Grace C Lovett, Julien D Schulberg, Amy L Hamilton, Emily K Wright, Tom R Sutherland, Alyson L Ross, Michael A Kamm
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Abstract

Background: Transmural healing is emerging as a key treatment target in Crohn's disease. This study aimed to determine the role of magnetic resonance imaging (MRI) and intestinal ultrasound (IUS) in the assessment of the radiologic response of Crohn's disease strictures to treatment.

Methods: The STRIDENT (Stricture Definition and Treatment) study was a randomized controlled trial of (2:1) intensive high-dose adalimumab combined with a thiopurine vs standard dose monotherapy adalimumab in patients with stricturing Crohn's disease. Clinical response was defined as a reduction in the Obstructive Symptom Score at 12 months. Intestinal ultrasound was performed at baseline, 4, 8, and 12 months and MRI at baseline and 12 months. This study examines secondary outcomes of stricture resolution and changes in stricture morphology with treatment.

Results: Of 77 patients, 52 were in the intensive treatment group and 25 in the standard therapy group. Clinical response was achieved in 56 of 77 patients (73%). Complete stricture resolution occurred in 17 patients on IUS (29%) and 16 patients on MRI (22%). Stricture improvement occurred in 23 of 59 patients on IUS (39%) and 24 of 72 patients on MRI (33%). Bowel wall thickness improved at 12 months on both IUS (P < .0001) and MRI (P < .001) and was significantly lower in clinical responders (IUS P = .003) and those with fecal calprotectin < 100 µg/g (IUS P < .001; MRI P = .001).

Conclusions: Radiologic severity of Crohn's disease strictures can improve with drug treatment, with complete stricture resolution observed in some. Intestinal ultrasound and MRI are effective modalities for monitoring the treatment response in patients with stricturing Crohn's disease (STRIDENT Drug Therapy Study: NCT03220841).

用磁共振成像和肠道超声评估克罗恩病狭窄治疗反应:STRIDENT随机试验。
背景:跨壁愈合正在成为克罗恩病的关键治疗靶点。本研究旨在确定磁共振成像(MRI)和肠道超声(IUS)在评估克罗恩病狭窄治疗的放射学反应中的作用。方法:STRIDENT(狭窄定义和治疗)研究是一项随机对照试验,(2:1)强化大剂量阿达木单抗联合硫嘌呤与标准剂量阿达木单抗单药治疗狭窄性克罗恩病患者。临床缓解被定义为12个月时阻塞性症状评分的降低。在基线、4、8和12个月进行肠道超声检查,在基线和12个月进行MRI检查。本研究考察了治疗后狭窄消退和狭窄形态改变的次要结果。结果:77例患者中,强化治疗组52例,标准治疗组25例。77例患者中有56例(73%)达到临床缓解。在IUS检查中17例(29%)和MRI检查中16例(22%)狭窄完全消失。59例IUS患者中有23例(39%)狭窄改善,72例MRI患者中有24例(33%)狭窄改善。结论:克罗恩病狭窄的放射学严重程度可以通过药物治疗得到改善,在一些患者中观察到完全的狭窄消退。肠道超声和MRI是监测狭窄性克罗恩病患者治疗反应的有效方法(STRIDENT药物治疗研究:NCT03220841)。
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来源期刊
Inflammatory Bowel Diseases
Inflammatory Bowel Diseases 医学-胃肠肝病学
CiteScore
9.70
自引率
6.10%
发文量
462
审稿时长
1 months
期刊介绍: Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.
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