Background and aims: Bowel damage [BD] will develop in the majority of Crohn's disease [CD] patients. Recently, the Lémann Index [LI] was developed to measure BD. Methods: This was a prospective single-center cohort study. All included patients underwent full evaluation for bowel damage before starting anti-TNF therapy and every year thereafter. BD at baseline and during follow-up was measured using the LI. We assessed the impact of anti-TNF therapy on BD. We also assessed the sensitivity to change of the LI and the relationship between BD progression and disease outcomes, including the need for surgery. Results: Thirty CD patients were enrolled [13 on infliximab, 17 on adalimumab]. Median baseline LI was 9.1 [range, 1.6-34.1]. Median follow up was 32.5 months [range, 10-64]. By a ROC curve analysis, a LI > 4.8 defined CD subjects with BD. Any change > 0.3 in the LI was related to BD change [AUC 0.98]. During follow-up, 83% of subjects had BD regression and 17% had BD progression. Anti-TNF therapy significantly reduced LI at 12 months [p=0.007]. Subjects with BD progression were more likely to undergo major abdominal surgery through the follow-up period [HR 0.19, p=0.005]. Conclusion: The LI has good sensitivity to change. Anti-TNFs agents are able to reverse BD in some CD patients. BD progression as measured by the LI may be predictive of major abdominal surgery in these patients.

Bowel damage as assessed by the Lémann Index is reversible on anti-TNF therapy for Crohn's disease

G. Fiorino;A. Repici;A. Malesci;S. Danese
2015-01-01

Abstract

Background and aims: Bowel damage [BD] will develop in the majority of Crohn's disease [CD] patients. Recently, the Lémann Index [LI] was developed to measure BD. Methods: This was a prospective single-center cohort study. All included patients underwent full evaluation for bowel damage before starting anti-TNF therapy and every year thereafter. BD at baseline and during follow-up was measured using the LI. We assessed the impact of anti-TNF therapy on BD. We also assessed the sensitivity to change of the LI and the relationship between BD progression and disease outcomes, including the need for surgery. Results: Thirty CD patients were enrolled [13 on infliximab, 17 on adalimumab]. Median baseline LI was 9.1 [range, 1.6-34.1]. Median follow up was 32.5 months [range, 10-64]. By a ROC curve analysis, a LI > 4.8 defined CD subjects with BD. Any change > 0.3 in the LI was related to BD change [AUC 0.98]. During follow-up, 83% of subjects had BD regression and 17% had BD progression. Anti-TNF therapy significantly reduced LI at 12 months [p=0.007]. Subjects with BD progression were more likely to undergo major abdominal surgery through the follow-up period [HR 0.19, p=0.005]. Conclusion: The LI has good sensitivity to change. Anti-TNFs agents are able to reverse BD in some CD patients. BD progression as measured by the LI may be predictive of major abdominal surgery in these patients.
2015
Anti-TNF; Bowel damage; Crohn's disease; Inflammatory bowel disease; Lémann Index; Adalimumab; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Non-Steroidal; Crohn Disease; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infliximab; Injections; Intravenous; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Pilot Projects; Proportional Hazards Models; Prospective Studies; Sensitivity and Specificity; Treatment Outcome; Young Adult; Severity of Illness Index; Gastroenterology; Medicine (all)
File in questo prodotto:
File Dimensione Formato  
2015 J Crohns Colitis.pdf

accesso aperto

Tipologia: Versione Editoriale (PDF)
Licenza: Creative commons
Dimensione 873.15 kB
Formato Adobe PDF
873.15 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/13465
Citazioni
  • ???jsp.display-item.citation.pmc??? 13
  • Scopus 61
  • ???jsp.display-item.citation.isi??? 56
social impact