Mucosal Healing Predicts Long-term Outcome of Maintenance Therapy with Infliximab in Crohn's Disease
Mucosal Healing Predicts Long-term Outcome of Maintenance Therapy with Infliximab in Crohn's Disease
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DOI：
10.1002/ibd.20927
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发表时间：
2009-09-01
影响因子：
4.9
通讯作者：
Rutgeerts, Paul
中科院分区：
文献类型：
--
作者：
Schnitzler, Fabian;Fidder, Herma;Rutgeerts, Paul
背景资料：英夫利昔单抗（IFX）治疗诱导粘膜愈合（MH）克罗恩病（CD）患者，但MH油的影响IFX治疗在CID.Methods的长期结果仍有争议：我们研究了MH在长期治疗IFX在214 CID患者。共193例患者（85.5%）对诱导治疗有应答，31例患者（14.5%）为主要无应答者。他们在首次IFX前中位数0.7个月（四分位距[IQR] 0.1-6.9）内和开始IFX后中位数6.7个月（IQR 1.4-24.6）内接受了下消化道（GI）内镜检查，并进行了进一步分析。IFX治疗的长期和MH的结果之间的关系进行了study.Results：MH观察在67.8%的183个初始应答者（n = 124），与83例完全愈合（45.4%）和41例部分愈合（22.4%）。从一开始就接受IFX治疗的患者发生MH的频率（76.9% MH率）高于间歇性治疗（61.0% MH率; P = 0.0222，比值比[OR] 2.14，95%置信区间[CI] 1.11-4.12）。皮质类固醇（CS）伴随治疗对MH有负面影响（CS患者为37.9%，无CS患者为63.2%; P = 0.021，OR 0.36，95% CI 0.16-0.80）。在长期随访中，MH与腹部大手术（MAS）需求显著降低相关（14.1%的MH患者需要MAS，而无MH患者为38.4%：P < 0.0001）。结论：长期维持IFX治疗诱导的MH与I型疾病的长期结局改善相关，尤其是与腹部大手术需求降低相关。
Background: Infliximab (IFX) treatment induces mucosal healing (MH) in patients with Crohn's disease (CD) but the impact of MH oil the long-term outcome of IFX treatment in CID is still debated.Methods: We studied MH during long-term treatment with IFX in 214 CID patients. A total of 193 patients (85.5%) responded to induction therapy and 31 patients (14.5%) were primary nonresponders. They underwent lower gastrointestinal (GI) endoscopy within a median of 0.7 months (interquartile range [IQR] 0.1-6.9) prior to first IFX and after a median of 6.7 months (IQR 1.4-24.6) after start of IFX and were further analyzed. The relationship between the outcome of IFX treatment long-term and MH was studied.Results: MH was observed in 67.8% of the 183 initial responders (n = 124), with 83 patients having complete healing (45.4%) and 41 having partial healing (22.4%). Scheduled IFX treatment from the start resulted in MH more frequently (76.9% MH rate) than episodic treatment (61.0% MH rate; P = 0.0222, odds ratio [OR] 2.14, 95% confidence interval [CI] 1.11-4.12). Concomitant treatment with corticosteroids (CS) had a negative impact on MH (37.9% in patients with CS versus 63.2% in patients without CS; P = 0.021, OR 0.36, 95% CI 0.16-0.80). MH was associated with a significantly lower need for major abdominal surgery (MAS) during long-term follow-up (14.1% of patients with MH needed MAS versus 38.4% of patients Without MH: P < 0.0001).Conclusions: MH induced by long-term maintenance IFX treatment is associated with an improved long-term outcome of the I disease especially with a lower need for major abdominal surgeries.