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Article Dans Une Revue Gut Année : 2017

Efficacy of adalimumab in patients with Crohn's disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study

1 Service de Gastroentérologie [Hôpital Beaujon]
2 Service d'hépato-gastro-entérologie
3 Département d'hépatologie et de gastroentérologie
4 Service de gastro-entérologie et nutrition clinique
5 Service de Gastro-entérologie [CHU Cochin]
6 Service des Maladies de l'Appareil Digestif et de la Nutrition [CHRU Lille]
7 LIRIC - Lille Inflammation Research International Center - U 995
8 Hôpital universitaire Robert Debré [Reims]
9 Service d'hépato-gastro-entérologie, cancérologie digestive et assistance nutritionnelle [CHU de Nantes]
10 Hépato-Gastro-Onco-Entérologie [CHRU de Tours]
11 CHU Saint-Antoine [AP-HP]
12 Service d'hépato-gastro-entérologie
13 Service d'Hépato-gastro-entérologie [CHRU Nancy]
14 Pôle Maladies de l'appareil digestif [CHU Toulouse]
15 Service d'Hépato-Gastroentérologie [CHU Rouen]
16 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
17 UNIROUEN - Université de Rouen Normandie
18 IRIB - Institute for Research and Innovation in Biomedicine
19 Service d'Hépato Gastroenterologie [CHU Amiens-Picardie]
20 APY - Autophagie infection et immunité - Autophagy Infection Immunity
21 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
22 Service de Gastro-entérologie et Hépatologie [CHU Saint-Etienne]
23 Hépato-gastro-entérologie
24 Service des Maladies de l'Appareil Digestif [CHU Rennes]
25 Département d'Hépato-Gastroentérologie
26 Gastroenterology
27 Université de Liège
28 Hôpital Beaujon [AP-HP]
29 CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
Franck Carbonnel
Matthieu Allez
Silvio Danese
  • Fonction : Auteur
  • PersonId : 907725

Résumé

Objective: The efficacy of anti-tumour necrosis factors (anti-TNFs) in patients with Crohn's disease (CD) and symptomatic small bowel stricture (SSBS) is controversial. The aim of this study was to estimate the efficacy of adalimumab in these patients and to identify the factors predicting success.Design: We performed a multicentre, prospective, observational cohort study in patients with CD and SSBS. The included patients underwent magnetic resonance enterography at baseline and subsequently received adalimumab. The primary endpoint was success at week 24, defined as adalimumab continuation without prohibited treatment (corticosteroids after the eight week following inclusion, other anti-TNFs), endoscopic dilation or bowel resection. The baseline factors independently associated with success were identified using a logistic regression model, leading to a simple prognostic score. Secondary endpoints were prolonged success after week 24 (still on adalimumab, without dilation nor surgery) and time to bowel resection in the whole cohort.Results From January 2010 to December 2011, 105 patients were screened and 97 were included. At week 24, 62/97 (64%) patients had achieved success. The prognostic score defined a good prognosis group with 43/49 successes, an intermediate prognosis group with 17/28 successes and a poor prognosis group with 1/16 successes. After a median follow-up time of 3.8 years, 45.7%±6.6% (proportion±SE) of patients who were in success at week 24 (ie, 29% of the whole cohort) were still in prolonged success at 4 years. Among the whole cohort, 50.7%±5.3% of patients did not undergo bowel resection 4 years after inclusion.Conclusions: A successful response to adalimumab was observed in about two-thirds of CD patients with SSBS and was prolonged in nearly half of them till the end of follow-up. More than half of the patients were free of surgery 4 years after treatment initiation.
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Dates et versions

hal-01639644 , version 1 (03-05-2018)

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Paternité - Pas d'utilisation commerciale

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Yoram Bouhnik, Franck Carbonnel, David Laharie, Carmen Stefanescu, Xavier Hebuterne, et al.. Efficacy of adalimumab in patients with Crohn's disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study. Gut, 2017, 67 (1), pp.53-60. ⟨10.1136/gutjnl-2016-312581⟩. ⟨hal-01639644⟩
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