title: Effects of infliximab therapy on transmural lesions as assessed by magnetic resonance enteroclysis in patients with ileal Crohn's disease.
abstract: OBJECTIVE
  Anti TNF therapy induces mucosal healing in patients with Crohn's disease, but the effects on transmural inflammation in the ileum are not well understood. Magnetic resonance-enteroclysis (MRE) offers excellent imaging of transmural and peri-enteric lesions in Crohn's ileitis and we aimed to study its responsiveness to anti TNF therapy.
  
  
  METHODS
  In this multi-center prospective trial, anti TNF naïve patients with ileal Crohn's disease and with increased CRP and contrast enhanced wall thickening received infliximab 5 mg/kg at weeks 0, 2 and 6, and q8 weeks maintenance MRE was performed at baseline, 2 weeks and 6 months and assessed based on a predefined MRE score of severity in ileal Crohn's Disease.
  
  
  RESULTS
  Twenty patients were included; of those, 18 patients underwent MRE at week 2 and 15 patients at weeks 2 and 26 as scheduled. Inflammatory components of the MRE index decreased by ≥2 points and by ≥50% at week 26 (primary endpoint) in 40% and 32% of patients (per protocol and intention to treat analysis, respectively). The MRE index improved in 44% at week 2 and in 80% at week 26. Complete absence of inflammatory lesions was observed in 0/18 at week 2 and 13% (2/15) at week 26. The obstructive elements did not change. Clinical and CRP improvement occurred as early as wk 2, but only CDAI correlated with the MRE index.
  
  
  CONCLUSIONS
  Improvement of MRE occurs from 2 weeks after infliximab therapy onwards and correlates with clinical response but normalization of MRE is rare.
authors: University of Toronto, Ontario, Canada; University of Toronto, Ontario, Canada. Electronic address: gvanassche@mtsinai.on.ca.
authors: Gert
authors: G
authors: Van Assche
authors: Karin A
authors: KA
authors: Herrmann
authors: Edouard
authors: E
authors: Louis
authors: Simon M
authors: SM
authors: Everett
authors: Jean-Frédéric
authors: JF
authors: Colombel
authors: Jean-François
authors: JF
authors: Rahier
authors: Dirk
authors: D
authors: Vanbeckevoort
authors: Paul
authors: P
authors: Meunier
authors: Damian
authors: D
authors: Tolan
authors: Olivier
authors: O
authors: Ernst
authors: Paul
authors: P
authors: Rutgeerts
authors: Séverine
authors: S
authors: Vermeire
authors: Isolde
authors: I
authors: Aerden
authors: Alessandra
authors: A
authors: Oortwijn
authors: Thomas
authors: T
authors: Ochsenkühn
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D003287:Contrast Media; D003424:Crohn Disease / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005682:Gadolinium; D006801:Humans; D007079:Ileitis / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D000069285:Infliximab; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D003287:Contrast Media; D002097:C-Reactive Protein; D005682:Gadolinium; D000069285:Infliximab
keywords: Anti-TNF therapy; Complications; Crohn's disease; Imaging; MR enteroclysis