Efficacy of adalimumab in patients with Crohn's disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study

Yoram Bouhnik 1 Franck Carbonnel 2, 3 David Laharie 4 Carmen Stefanescu 1 Xavier Hebuterne 5 Vered Abitbol 6 Maria Nachury 7 Hedia Brixi 8 Arnaud Bourreille 9 Laurence Picon 10 Anne Bourrier 11 Matthieu Allez 12 Laurent Peyrin-Biroulet 13 Jacques Moreau 14 Guillaume Savoye 15 Mathurin Fumery 16 Stephane Nancey 17, 18 Xavier Roblin 19 Romain Altwegg 20 Guillaume Bouguen 21 Gilles Bommelaer 22 Silvio Danese 23 Edouard Louis 24 Magaly Zappa 25 Jean-Yves Mary 26
Abstract : Objective: The efficacy of anti-tumour necrosis factors (anti-TNFs) in patients with Crohn's disease (CD) and symptomatic small bowel stricture (SSBS) is controversial. The aim of this study was to estimate the efficacy of adalimumab in these patients and to identify the factors predicting success. Design: We performed a multicentre, prospective, observational cohort study in patients with CD and SSBS. The included patients underwent magnetic resonance enterography at baseline and subsequently received adalimumab. The primary endpoint was success at week 24, defined as adalimumab continuation without prohibited treatment (corticosteroids after the eight week following inclusion, other anti-TNFs), endoscopic dilation or bowel resection. The baseline factors independently associated with success were identified using a logistic regression model, leading to a simple prognostic score. Secondary endpoints were prolonged success after week 24 (still on adalimumab, without dilation nor surgery) and time to bowel resection in the whole cohort. Results From January 2010 to December 2011, 105 patients were screened and 97 were included. At week 24, 62/97 (64%) patients had achieved success. The prognostic score defined a good prognosis group with 43/49 successes, an intermediate prognosis group with 17/28 successes and a poor prognosis group with 1/16 successes. After a median follow-up time of 3.8 years, 45.7%±6.6% (proportion±SE) of patients who were in success at week 24 (ie, 29% of the whole cohort) were still in prolonged success at 4 years. Among the whole cohort, 50.7%±5.3% of patients did not undergo bowel resection 4 years after inclusion. Conclusions: A successful response to adalimumab was observed in about two-thirds of CD patients with SSBS and was prolonged in nearly half of them till the end of follow-up. More than half of the patients were free of surgery 4 years after treatment initiation.
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https://hal-clermont-univ.archives-ouvertes.fr/hal-01639644
Contributeur : Jeannette Ouertani <>
Soumis le : jeudi 3 mai 2018 - 15:14:57
Dernière modification le : mardi 5 juin 2018 - 10:14:32

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Yoram Bouhnik, Franck Carbonnel, David Laharie, Carmen Stefanescu, Xavier Hebuterne, et al.. Efficacy of adalimumab in patients with Crohn's disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study. Gut, BMJ Publishing Group, 2017, 67, pp.53-60. 〈10.1136/gutjnl-2016-312581〉. 〈hal-01639644〉

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