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* = Presenting author

P418 Looking beyond the mucosa: transmural healing after one-year anti-TNF± therapy in Crohn's disease

M. Serio*1, K. Efthymakis1, A. Pierro2, A. Milano1, F. Laterza1, G. Maselli2, A. Bonitatibus1, R. De Prophetis1, G. Sallustio2, M. Neri1

1Università "G. D'Annunzio", Medicine and Aging Sciences and CESI, Chieti, Italy, 2Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Radiology Department, Campobasso, Italy

Background

Crohn's disease (CD) may show full-thickness involvement of the bowel wall,frequently with extramural complications.Although the capability of anti-TNFα agents to induce and maintain clinical and endoscopical remission has repeatedly been described,their role in the treatment of transmural inflammation is still unclear.

Aim of this study was to analyze transmural healing (TH) in consecutive CD patients after a one-year treatment with anti-TNFα and to correlate TH with mucosal healing (MH),biological markers(CRP and fecal calprotectin) and clinical activity(CDAI)

Methods

11 patients with moderate to severe ileocolic CD were enrolled. All underwent ileocolonoscopy and MRI-enterography before and after one-year treatment with anti-TNFα; clinical remission was defined as CDAI< 150,response as a 70-point reduction from baseline.CRP and fecal calprotectin(FC) (positivity cut-off respectively >0,50 mg/dl and >150 μg/gr) were also measured.Endoscopic activity was assessed by SES-CD,range 0-40,with remission defined as score<3 and response as a 50% decrease from baseline at one year.MRI activity was measured by MRI-enterography global score (MEGS),range 0-296,a score which takes into account transmural and extramural features of disease,with active disease defined as a score ≥1,and response as above.

Results

We enrolled 6 males and 5 females,mean age 38 ± 14 ys,mean disease duration 7 ± 5 ys.According to the Montreal classification the phenotype was L1 in 27%,L2 in 9% and L3 in 64%;the behavior was B1 in 9%,B2 in 64%,and B3 in 27%; resectional surgery related to CD was observed in 9%.Signs of mesenteric inflammation were only lymph node enlargement or comb-sign.3 patients were treated with IFX,8 with ADA.Mean SES-CD,MEGS,CDAI,CRP and FC values significantly decreased at one year(table);56% of patients had clinical remission and 9% response,biological remission was achieved in 54% and 72% according to FC and CRP respectively;endoscopic improvement was 64%,18% achieved MH.Mean MEGS score was unrelated to MH (p=0.8);18% had transmural improvement but none had complete normalization of MRI finding.Elevated CRP at one year was correlated with presence of extramural involvement only(p=0.04) and mean CRP level were higher (4,3 ± 5 ng/ml) in the presence of comb-sign(p=0.04).

BaselineAfter 1 yearStatistical Analysis
SES-CD11 ± 47 ± 4p=0.001
MEGS30 ± 1319 ± 10p=0.001
Transmural subscore22 ± 1214 ± 8p=0.002
Extramural subscore90%75%p=ns
CDAI243 ± 85169 ± 103p=0.03
CRP3,2 ± 32,5 ± 4p=0.03
FC290 ± 180169 ± 163p=0.02

Conclusion

Biologic therapy is effective in inducing clinical,biochemical and endoscopical remission of CD while extramural inflammation may persist longer than one year,as indicated by persistently elevated CRP levels.Transmural healing probably needs longer therapy to be achieved.