Ultrasonography tight control and monitoring in Crohn’s disease during different biological therapies: a multicenter study

BACKGROUND & AIM Bowel Ultrasonography (BUS) is a non-invasive tool for evaluating bowel activity in Crohn's disease (CD) patients. Aim of our multicenter study was to assess whether BUS helps to monitor intestinal activity improvement/resolution following different biological therapies. METHODS Adult CD patients were prospectively enrolled at 16 sites in Italy. Changes in BUS parameters [i.e. bowel wall thickening (BWT), lesion length, echopattern, blood flow changes and transmural healing (TH: normalization of all BUS parameters)] were analyzed at baseline and after 3, 6 and 12 months of different biological therapies. RESULTS One hundred and eighty-eight out of 201 CD patients were enrolled and analyzed (116 males [62%]; median age 36 years). Fifty-five percent of patients were treated with adalimumab, 16% with infliximab, 13% with vedolizumab and 16% with ustekinumab. TH rates at 12 months were 27.5% with an NNT of 3.6. TH at 12 months after adalimumab was 26.8%, 37% after infliximab, 27.2% after vedolizumab and 20% after ustekinumab. Mean BWT improvement from baseline was statistically significant at 3 and 12 months (p<0.0001). Median Harvey-Bradshaw index, C-reactive protein and fecal calprotectin decreased after 12 months from baseline (p<0.0001). Logistic regression analysis showed colonic lesion was associated with a higher risk of TH at 3 months and a greater BWT at baseline was associated with a lower risk of TH at 3 months [p=0.03 (OR 0.70, 95%CI 0.50-0.97)] and 12 months [p=0.01 (OR 0.58, 95%CI 0.38-0.89)]. At 3 months therapy optimization during the study was the only independent factor associated with a higher risk of no ultrasonographic response [p=0.02 (OR 3.34, 95%CI 1.18-9.47)] and at 12 months disease duration [p=0.02 (OR 3.03, 95%CI 1.15-7.94)]. CONCLUSION Data indicate that BUS is useful to monitor biologics-induced bowel activity improvement/resolution in CD.