Abscess; Adalimumab; Anti-TNF; Crohn’s Disease; Surgery
Abstract :
[en] BACKGROUND & AIMS: The management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging, and surgery with delayed intestinal resection is often recommended. The aims of this study were to estimate the success rate of adalimumab (ADA) in patients with CD with an intra-abdominal abscess resolved without surgery, and to identify predictive factors for success. METHODS: A multicenter, prospective study was conducted in biologic-naïve patients with CD with resolved intra-abdominal abscess treated with ADA with a 2-year follow-up. The primary endpoint was ADA failure at week (W) 24 defined as a need for steroids after W12, intestinal resection, abscess recurrence, and clinical relapse. Secondary post-hoc endpoint was the long-term success defined as the survival without abscess relapse or intestinal resection at W104. The factors associated with ADA failure at W24 and W104 were identified using a logistic and a Cox regression, respectively. RESULTS: From April 2013 to December 2017, 190 patients from 27 GETAID centers were screened, and 117 were included in the analysis. Fifty-eight patients (50%) were male, and the median age at baseline was 28 years. At W24, 87 patients (74%; 95% confidence interval [CI], 65.5%-82.0%; n = 117) achieved ADA success. Among the 30 patients with ADA failure, 15 underwent surgery. At W104, the survival rate without abscess recurrence or surgery was 72.9% (95% CI, 62.1%-79.8%; n = 109). Abscess drainage was significantly associated with ADA failure at W24 (odds ratio, 4.18; 95% CI, 1.06-16.5; P =0 .043). Disease duration (hazard ratio [HR], 1.32; 95% CI, 1.09-1.59; P = .008), abscess drainage (HR, 5.59; 95% CI, 2.21-14.15; P = .001), and inflammatory changes in mesenteric fat (HR, 0.4; 95% CI, 0.17-0.94; P = .046) were significantly associated with ADA failure at W104. CONCLUSION: Provided that the abscess was carefully managed before initiating medical treatment, this study showed the high efficacy of ADA in the short and long term in biologic-naïve patients with CD complicated by an intra-abdominal abscess. CLINICALTRIALS: gov, Number: NCT02856763.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Bouhnik, Yoram; Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur
Pineton de Chambrun, Guillaume; Department of Gastroenterology, Saint-Eloi Hospital, Montpellier University,
Lambert, Jérôme; Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France.
Nachury, Maria; University Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for
Seksik, Philippe; Département de Gastroentérologie, Hôpital Saint Antoine, Sorbonne Université,
Altwegg, Romain; Department of Gastroenterology, Hôpital Saint-Éloi, CHU, Montpellier, France.
Vuitton, Lucine; Department of Gastroenterology, Besançon University Hospital, Besançon, France.
Stefanescu, Carmen; Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur
Nancey, Stéphane; Department of Gastroenterology, Lyon-Sud Hospital, Lyon University, Lyon, France.
Aubourg, Alexandre; Department of Gastroenterology, Tours University Hospital, Tours, France.
Serrero, Mélanie; Department of Gastroenterology, Hôpital Nord, Marseille University, Marseille,
Filippi, Jérôme; Department of Gastroenterology, Nice University Hospital, Nice, France.
Desseaux, Kristell; Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France.
Viennot, Stéphanie; Department of Gastroenterology, University Hospital of Caen, Caen, France.
Abitbol, Vered; Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital
Boualit, Madina; Department of Gastroenterology, Valenciennes General Hospital, Valenciennes,
Bourreille, Arnaud; CHU Nantes, Institut des Maladies de l'Appareil Digestif, Department of
Giletta, Cyrielle; Department of Gastroenterology, Toulouse University Hospital, Hôpital Rangueil,
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