Ainora Maria Elena, Liguori Antonio, Mignini Irene, Cintoni Marco, Galasso Linda, Laterza Lucrezia, Lopetuso Loris Riccardo, Garcovich Matteo, Riccardi Laura, Gasbarrini Antonio, Scaldaferri Franco, Zocco Maria Assunta
Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy.
Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore - Rome, Largo A. Gemelli, 8, Rome 00168, Italy.
Therap Adv Gastroenterol. 2024 Jun 22;17:17562848241259289. doi: 10.1177/17562848241259289. eCollection 2024.
The approval of ustekinumab (UST) has opened new options for the treatment of Crohn's disease (CD), but potential markers predicting the efficacy of this interleukin-12/23 inhibitor are lacking. Contrast-enhanced ultrasound (CEUS) is non-invasive alternative to endoscopy, demonstrating early transmural changes after treatment induction.
We conducted a prospective monocentric study aiming to explore the value of multimodal intestinal ultrasound (IUS) in predicting the response to UST in patients with active CD who have been previously exposed to anti-tumour necrosis factor α (TNFα).
Consecutive patients with moderate-to-severe CD involving the terminal ileum who were scheduled to begin UST therapy were enrolled between January 2020 and October 2021 in the inflammatory bowel diseases outpatient centre. A complete IUS evaluation, including B-mode, Doppler, dynamic CEUS and elastography, was performed at the time of induction (T0) and after 8 (T1), 16 (T2), 24 (T3) and 48 (T4) weeks of therapy. Each IUS parameter and their variations from baseline were correlated with endoscopic response and mucosal healing after 1 year.
A total of 52 patients were included, 29 (55.8%) of which reached endoscopic response at T4. The univariate analysis revealed that, between T3 and T0, the percentage changes of bowel wall thickness, Limberg score, mean signal intensity, rise time, wash-in rate, C reactive protein and Harvey-Bradshaw Index were associated with long-term therapeutic outcome. Based on the above parameters, we developed an IUS score that showed a good performance in predicting 1 year-endoscopic response (area under the curve: 0.91).
Multimodal ultrasound could be helpful to predict long-term therapeutic outcome in patients with CD treated with UST.
NCT05987501.
优特克单抗（UST）的获批为克罗恩病（CD）的治疗开辟了新选择，但缺乏预测这种白细胞介素-12/23抑制剂疗效的潜在标志物。对比增强超声（CEUS）是一种非侵入性的内镜替代方法，可显示治疗诱导后的早期透壁变化。
我们进行了一项前瞻性单中心研究，旨在探讨多模态肠道超声（IUS）在预测先前接受过抗肿瘤坏死因子α（TNFα）治疗的活动性CD患者对UST反应中的价值。
2020年1月至2021年10月期间，在炎症性肠病门诊中心纳入了计划开始UST治疗的累及回肠末端的中重度CD连续患者。在诱导期（T0）以及治疗8周（T1）、16周（T2）、24周（T3）和48周（T4）后进行了完整的IUS评估，包括B超、多普勒、动态CEUS和弹性成像。将每个IUS参数及其相对于基线的变化与1年后的内镜反应和黏膜愈合情况进行关联。
共纳入52例患者，其中29例（55.8%）在T4时达到内镜反应。单因素分析显示，在T3和T0之间，肠壁厚度、林贝格评分、平均信号强度、上升时间、流入率、C反应蛋白和哈维-布拉德肖指数的百分比变化与长期治疗结果相关。基于上述参数，我们制定了一个IUS评分，该评分在预测1年内镜反应方面表现良好（曲线下面积：0.91）。
多模态超声有助于预测接受UST治疗的CD患者的长期治疗结果。
NCT05987501
