Long-Term Results of Drug Treatment for Crohn's Disease Strictures.
Grace C Lovett, Julien D Schulberg, Amy L Hamilton et al.
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In 30 seconds
This randomized controlled trial examined long-term outcomes of drug treatment for symptomatic Crohn’s disease strictures. Patients received either intensive adalimumab-based treatment or standard-dose adalimumab monotherapy, with follow-up interviews at a minimum of 4 years. Clinical responders at 12 months had a lower rate of surgical resection than nonresponders (20% vs 52%; P < .001). The baseline stricture MRI risk score predicted surgery-free survival (odds ratio, 2.34; 95% confidence interval, 1.32-4.16; P = .004). The authors report that response was durable in a majority and consider drug treatment a viable initial approach.
Key findings
- Clinical responders had fewer surgical resections than nonresponders (20% vs 52%; P < .001).
- The MRI stricture risk score predicted surgery-free survival (odds ratio, 2.34; 95% confidence interval, 1.32-4.16; P = .004).
- After the initial 12-month study, 12 of 77 patients (16%) underwent endoscopic dilation and 22 of 77 (29%) required surgery.
Why it matters
Symptomatic Crohn’s strictures can lead to endoscopic or surgical intervention. These long-term findings suggest that patients who respond clinically to adalimumab may have a lower subsequent rate of resection, while MRI features may help identify differences in surgery-free outcomes. The results add longer-term context to the potential role of medical treatment in this population.
What to keep in mind
Long-term outcomes were assessed through follow-up interviews after the 12-month trial; 13 of 77 patients withdrew during the initial study.