Adalimumab may ease small bowel stricture in Crohn's disease

Last Updated: 2017-02-13

By David Douglas

NEW YORK (Reuters Health) - The anti-tumor necrosis factor (anti-TNF) agent adalimumab appears to be effective against symptomatic small bowel stricture associated with Crohn's disease (CD), according to the industry-funded, observational CREOLE study.

Lead author Dr. Yoram Bouhnik told Reuters Health by email that there is controversy over use of anti-TNFs in such circumstances, but the new findings "will probably modify recommendations as to how to best approach patients with CD and symptomatic small bowel stricture."

Dr. Bouhnik of Hôpital Beaujon in Clichy, France, and colleagues followed 97 patients who underwent treatment with adalimumab. Their results were published online January 24 in Gut.

At six months, nearly two-thirds (64%) showed success in that they continued with adalimumab without need of corticosteroids or other anti-TNFs or of endoscopic dilation or bowel resection.

The team also found that combined treatment with adalimumab and immunosuppressive agents was associated with an increased probability of success compared with adalimumab alone. Such results, they say, "should be confirmed in a randomised controlled clinical trial."

After a median follow-up of 3.8 years, 45.7% of patients who responded initially continued to show success. In the whole cohort, more than half (50.7%) of the patients had not undergone bowel resection four years after inclusion.

The researchers also say that they developed an "easy-to-use predictive score" of adalimumab success, based on clinical and imaging factors.

This score, Dr. Bouhnik said, "is able to clearly distinguish patients who will have benefit of medical treatment than those who won't. The CREOLE Score should be used in clinical practice, especially in pluridisciplinary meetings with gastroenterologists, surgeons and radiologist to propose the most adapted solution for each patient."

The researchers concede that a controlled trial "of anti-TNF versus surgery is needed to assess which is the best option to preserve quality of life."

However, they do add, "Our score helps in making a factual decision between medical or surgical treatment rather than empirical."

AbbVie, which sells adalimumab as Humira, funded the study. The authors report several financial ties to the company, including paid expert testimony.

SOURCE: http://bit.ly/2l6eBfT

Gut 2017.