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Bowel Damage as Assessed by the Lémann Index is Reversible on Anti-TNF Therapy for Crohn’s Disease

Abstract : Background and aims: Bowel damage [BD] will develop in the majority of Crohn’s disease [CD] patients. Recently, the Lémann Index [LI] was developed to measure BD. Methods: This was a prospective single-center cohort study. All included patients underwent full evaluation for bowel damage before starting anti-TNF therapy and every year thereafter. BD at baseline and during follow-up was measured using the LI. We assessed the impact of anti-TNF therapy on BD. We also assessed the sensitivity to change of the LI and the relationship between BD progression and disease outcomes, including the need for surgery. Results: Thirty CD patients were enrolled [13 on infliximab, 17 on adalimumab]. Median baseline LI was 9.1 [range, 1.6–34.1]. Median follow up was 32.5 months [range, 10–64]. By a ROC curve analysis, a LI >4.8 defined CD subjects with BD. Any change >0.3 in the LI was related to BD change [AUC 0.98]. During follow-up, 83% of subjects had BD regression and 17% had BD progression. Anti-TNF therapy significantly reduced LI at 12 months [p=0.007]. Subjects with BD progression were more likely to undergo major abdominal surgery through the follow-up period [HR 0.19, p=0.005]. Conclusion: The LI has good sensitivity to change. Anti-TNFs agents are able to reverse BD in some CD patients. BD progression as measured by the LI may be predictive of major abdominal surgery in these patients.
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Submitted on : Tuesday, December 19, 2017 - 3:39:11 PM
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Gionata Fiorino, Cristiana Bonifacio, Mariangela Allocca, Alessandro Repici, Luca Balzarini, et al.. Bowel Damage as Assessed by the Lémann Index is Reversible on Anti-TNF Therapy for Crohn’s Disease. Journal of Crohn's and Colitis, Elsevier - Oxford University Press, 2015, 9 (8), pp.633 - 639. ⟨10.1093/ecco-jcc/jjv080⟩. ⟨hal-01667769⟩



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