scholarly journals Combination of Serological Biomarkers and Clinical Features To Predict Mucosal Healing in Crohn’s Disease: A Multicenter Cohort Study

2021 ◽  
Author(s):  
Nana Tang ◽  
Han Chen ◽  
Ruidong Chen ◽  
Wen Tang ◽  
Hongjie Zhang
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Statistical Significance ◽  
Mucosal Healing ◽  
Infliximab Treatment ◽  
Clinical Tool ◽  
Multicenter Cohort Study ◽  
Reactive Protein ◽  
Primary Model ◽  
Serological Biomarkers

Abstract Background Mucosal healing (MH) has become the treatment goal of patients with Crohn’s disease (CD). This study aims to develop a noninvasive and reliable clinical tool for individual evaluation of mucosal healing in patients with Crohn’s disease. Results The following variables were independently associated with the MH and were subsequently included into the prediction model: PLR (platelet to lymphocyte ratio), CAR (C-reactive protein to albumin ratio), ESR (erythrocyte sedimentation rate), HBI (Harvey-Bradshaw Index) score and infliximab treatment. A primary model and a simple model were established, respectively. The primary model performed better than the simple one in C-index (87.5% vs 83.0 %, p=0.004). There was no statistical significance between these two models in sensitivity (70.43% vs 62.61%, p=0.467), specificity (87.12% vs 80.69%, p=0.448), PPV (72.97% vs 61.54%, p=0.292), NPV (85.65% vs 81.39%, p=0.614), and accuracy (81.61% vs 74.71%, p=0.303). The primary model had good calibration and high levels of explained variation and discrimination in validation cohort. Conclusions This model can be used to predict MH in post-treatment CD patients. It can also be used as an indication of endoscopic surveillance to evaluate mucosal healing in patients with CD after treatment.

scholarly journals P138 Platelet-to-lymphocyte ratio index: a reliable tool for non-invasive assessment of endoscopic activity in small bowel Crohn’s Disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S225-S225
Author(s):  
V Macedo Silva ◽  
M Freitas ◽  
S Xavier ◽  
T Cúrdia Gonçalves ◽  
P Boal Carvalho ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
C Reactive Protein ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Non Invasive

Abstract Background The platelet-to-lymphocyte ratio (PLR) index has been a recent focus of investigation as a reliable marker of inflammation. This score was recently shown to have a good accuracy upon predicting endoscopic remission in patients with colonic Crohn’s Disease (CD). We aimed to assess the discriminative power of PLR index in patients with isolated small bowel CD. Methods Single center study of consecutive patients with isolated small bowel CD (L1 ± L4 disease according to Montreal classification) who underwent small bowel capsule endoscopy (SBCE) for assessment of endoscopic activity between January 2019 and December 2020. Only complete SBCEs were considered. CD endoscopic activity was classified according to the Lewis score (LS) value. Complete blood count, C-reactive protein and fecal calprotectin values were collected within 1 month of SBCE. Results Final sample included 49 patients, 35 (71.4%) of them females, with a mean age of 35.1±11.8 years. SBCE reported mucosal healing (LS<135) in 30.6% of the patients; mild activity (135≤LS<790) in 42.9% and moderate-to-severe activity (LS≥790) in 26.5% of the patients. PLR index positive correlation with LS was significant and moderate (k=0.597; p<0.001). This correlation was stronger than the one seen between fecal calprotectin (k=0.525; p=0.001) or C-reactive protein (k=0.321; p=0.029) and the LS score. In particular, PLR index presented an excellent accuracy for predicting patients with a moderate-to-severe endoscopic activity (AUC=0.908; 95%CI=0.816–0.999; p<0.001), with an optimal cut-off of PLR above 157 (sensitivity 92.3%; specificity 82.9%). The accuracy for prediction of mucosal healing was good (AUC=0.743; 95%CI=0.600–0.887; p=0.007), with an optimal cut-off of PLR below 126 (sensitivity 66.7%; specificity 80.0%). Conclusion PLR index demonstrated an excellent acuity for predicting patients with moderate to severe disease in small bowel CD. Moreover, it also demonstrated good acuity for predicting mucosal healing on this set of patients. These results come from a significant correlation of PLR index with endoscopic activity in small bowel CD. Our findings establish this index as a promising and easy-to-apply tool for non-invasive and regular follow-up of patients with small bowel CD.

scholarly journals Predictors of efficacy, mucosal healing and dose intensification during the first year of adalimumab therapy in patients with luminal and fistulizing Crohn’s disease. National data from Hungary

2011 ◽  
Vol 152 (36) ◽  
pp. 1433-1442 ◽  
Author(s):  
Lajos Sándor Kiss ◽  
Tamás Szamosi ◽  
Tamás Molnár ◽  
Pál Miheller ◽  
László Lakatos ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Efficacy ◽  
Mucosal Healing ◽  
C Reactive Protein ◽  
Medium Term ◽  
Dose Intensification ◽  
Azathioprine Therapy ◽  
Reactive Protein ◽  
Adalimumab Therapy

Adalimumab is a fully human monoclonal antibody targeting tumor necrosis factor with proven efficacy in the treatment of Crohn’s disease in clinical trials. The aim of the present study was to investigate the predictors of medium term clinical efficacy and mucosal healing during adalimumab therapy in patients with Crohn’s disease in specialized centers approved for biological therapy in Hungary. Methods: Data of 201 Crohn’s disease patients were prospectively captured (male/female: 112/89, median age: 24 years, duration: 8 years). Previous infliximab therapy was given in 97 (48.3%) patients, concomitant steroids in 41.3% and azathioprine in 69.2% (combined: 26.4%) of patients. Results: Overall clinical response and remission rates at 24 and 52 weeks were 78% and 52%, and 69.4% and 44.4%, respectively. Endoscopic improvement and healing was achieved in 43.1% and 23.6%, respectively. In a logistic regression model, clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, while normalized C-reactive protein at week 12, clinical remission at week 24, frequency of previous relapses and smoking were associated to endoscopic improvement/healing. Dose intensification to weekly dosing was needed in 16.4%. Parallel azathioprine therapy and clinical remission at week 12 was inversely associated to dose escalation to weekly dosing. Conclusion: Clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression, luminal disease and smoking are predictors for medium term clinical efficacy/mucosal healing during adalimumab therapy, while parallel azathioprine therapy may decrease the probability for dose escalation. Orv. Hetil., 2011, 152, 1433–1442.

Clinical disease activity, C-reactive protein normalisation and mucosal healing in Crohn's disease in the SONIC trial

Gut ◽  
2013 ◽  
Vol 63 (1) ◽  
pp. 88-95 ◽  
Author(s):  
Laurent Peyrin-Biroulet ◽  
Walter Reinisch ◽  
Jean-Frederic Colombel ◽  
Gerassimos J Mantzaris ◽  
Asher Kornbluth ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Mucosal Healing ◽  
Clinical Disease ◽  
C Reactive Protein ◽  
Clinical Disease Activity ◽  
Reactive Protein

scholarly journals P495 High C-reactive protein in Crohn's disease patients predicts nonresponse to infliximab treatment

2013 ◽  
Vol 7 ◽  
pp. S208
Author(s):  
E. Rodrigues-Pinto ◽  
F. Magro ◽  
J. Santos-Antunes ◽  
F. Vilas-Boas ◽  
S. Lopes ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Infliximab Treatment ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals P679 What is the best strategy after failure to anti-TNF? Ustekinumab or other anti-TNF?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S554-S554
Author(s):  
A Cerpa Arencibia ◽  
C Suarez Ferrer ◽  
J Poza Cordón ◽  
E Martín Arranz ◽  
L Ramírez ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Remission ◽  
Biological Treatment ◽  
Statistical Significance ◽  
Intestinal Resection ◽  
Remission Induction ◽  
Infliximab Treatment ◽  
Second Line ◽  
Intestinal Activity

Abstract Background After the appearance of new biologics are more treatment options for first and second-line individualising according to the characteristics of each patient. The efficacy of a second anti-TNF is lower than the initial treatment so a more efficient strategy could change the therapeutic target. Methods We included patients with an established diagnosis of Crohn’s disease who were on second-line biological treatment (ustekinumab or anti-TNF) after failure of a first anti-TNF (adalimumab or infliximab) treatment. Only patients in whom the indication was the ‘induction of remission of inflammatory activity’ so those patients in whom the indication was different from the intestinal activity (intestinal manifestations, perianal disease etc.) were selected were not considered valid for analysis. Patients who had undergone intestinal resection alone were included in the study if the indication of second-line biologic treatment was already established and no recurrence prophylaxis thereof. Results A total of 56 patients with an established diagnosis of Crohn’s disease stable tracking unit EII La Paz Hospital who were treated with second-line ustekinumab (21 patients, 37.5%) or anti-TNF (35 patients were included, 62.5%) for remission induction. Baseline characteristics of patients and their IBD are summarised in Table 1. The duration of biological treatment at the time of analysis was 1.48 years (SD: 1.2) for ustekinumab group and 3.55 years (SD 3.3) for the anti-TNF group. Ustekinumab group in 16/21 (76.2%) achieved clinical remission, 3/21 (14.3%) had no response while achieving remission (note that in one patient occurred exitus otherwise cause adenocarcinoma páncreas- unable to properly assess drug response), 2/21 patients (9.5%) did not answer. In the group of anti-TNF, 15/35 patients (42.8%) achieved clinical remission, 12/35 patients (34.3%) had response without remission, 8/35 patients (22.9%) No response. These differences between groups reached statistical significance (p = 0.015). Among patients who achieved a response / clinical remission included those wherein assessed by endoscopy identifying intestinal activity no statistically significant differences between groups vs. anti-TNF ustekinumab both SESCD (average 2 vs. 6.3 p = 0, 39) to the Ruttgerts in (mean 2.5 vs. 2, p = 0.67) postsurgical stage. Regarding the response/biological remission found no significant differences in CRP between ustekinumab and anti-TNF (4.55 vs. 5.79, p = 0.68) or with fecal calprotectin (276.25 vs. 268.82, p = 0.94). Conclusion In our experience, the second-line treatment with ustekinumab after the failure of a first anti-TNF has better remission rates and response to treatment with a second anti-TNF.

scholarly journals Gastrointestinal Ultrasound Can Predict Endoscopic Activity in Crohn’s Disease

2020 ◽  
Author(s):  
Fredrik Sævik ◽  
Odd Helge Gilja ◽  
Kim Nylund
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Wall Thickness ◽  
Color Doppler ◽  
High Sensitivity ◽  
Mucosal Healing ◽  
Reactive Protein ◽  
Endoscopic Remission ◽  
Gastrointestinal Ultrasound ◽  
Active Disease

Abstract Purpose To explore the ability of gastrointestinal ultrasound (GIUS) to separate patients in endoscopic remission from patients with active disease in a heterogeneous hospital cohort with Crohn’s disease (CD). Materials and Methods 145 CD patients scheduled for ileocolonoscopy were prospectively included. The endoscopic disease activity was quantified using the Simple Endoscopic Score for Crohn’s disease (SES-CD), and mucosal healing was strictly defined as SES-CD = 0. Ultrasound remission was defined as wall thickness < 3 mm (< 4 mm in the rectum). Additionally, SES-CD was compared to color Doppler, Harvey Bradshaw’s index (HBI), C-reactive protein (CRP) and calprotectin. 23 patients were examined by two investigators for interobserver assessment. Results 102 had active disease and 43 patients were in remission. GIUS yielded a sensitivity of 92.2 % and a specificity of 86 % for wall thickness and a sensitivity of 66.7 % and a specificity of 97.7 % for color Doppler. The sensitivity and specificity were 34.3 % and 88.4 %, respectively, for HBI, 35.7 % and 82.9 %, respectively, for CRP and 55.9 % and 82.1 %, respectively, for calprotectin. The interobserver analysis revealed excellent agreement for wall thickness (k = 0.90) and color Doppler (k = 0.91) measurements. Conclusion GIUS has a high sensitivity for detecting endoscopic activity. Accordingly, bowel ultrasound has the potential to reduce the number of routine ileocolonoscopies in patients with CD.

Sa1202 Relationships Between Clinical Remission, C-Reactive Protein Normalization and Mucosal Healing in Crohn's Disease: Analyses From the SONIC trial

2013 ◽  
Vol 144 (5) ◽  
pp. S-228 ◽  
Author(s):  
Laurent Peyrin-Biroulet ◽  
Walter Reinisch ◽  
Jean-Frederic Colombel ◽  
Gerassimos J. Mantzaris ◽  
Asher Kornbluth ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Remission ◽  
Mucosal Healing ◽  
C Reactive Protein ◽  
Reactive Protein
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