title: Magnetic resonance enterography findings as predictors of clinical outcome following antitumor necrosis factor treatment in small bowel Crohn's disease.
abstract: OBJECTIVE
  To determine whether specific magnetic resonance enterography (MRE) findings can predict outcome following commencement of antitumor necrosis factor (aTNF) in small bowel Crohn's disease (CD) PATIENTS AND METHODS: This was a single-centre retrospective study of patients with CD who commenced aTNF (infliximab or adalimumab) between 2007 and 2013. Patients who had an MRE within 6 months before commencing aTNF were included. The primary end-point was the need for CD-related surgery. The secondary end-points were time to surgery and time to treatment failure. The relationship between these end-points, clinical variables and specific MRE findings were studied.
  
  
  RESULTS
  Four hundred and eighteen patients commenced aTNF for CD during the study period. Seventy-five patients had an MRE within 6 months before commencing aTNF (30 infliximab; 45 adalimumab). The median time from MRE to commencing aTNF was 43 days (IQR 19.5-87 days). Eighteen of 75 (24%) had surgery during a median follow-up of 16.7 months (IQR 9.0-30.1 months). Patients with small bowel stenosis (SBS) on MRE were at a significantly higher risk of requiring surgery: 12/18 (66.7%) versus 6/57 (10.5%) (P<0.001). Time to surgery was significantly shorter in patients with SBS on MRE (P<0.001). In a multivariate analysis, SBS (P<0.0001, hazard ratio 26.45, 95% confidence interval 5.45-128.49) and presence of penetrating complications (P=0.003, hazard ratio 36.53, 95% confidence interval 3.40-393.19) were associated independently with time to surgery.
  
  
  CONCLUSIONS
  SBS and penetrating complications on MRE are associated independently with a need for early surgery and treatment failure in patients commencing aTNF.
authors.affiliation: aCentre for Colorectal Disease bDepartment of Radiology, School of Medicine and Medical Science, St Vincent's University Hospital, University College Dublin, Dublin, Ireland.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gibson
authors.forename: David J
authors.initials: DJ
authors.lastname: Murphy
authors.forename: Anna E
authors.initials: AE
authors.lastname: Smyth
authors.forename: Sinead H
authors.initials: SH
authors.lastname: McEvoy
authors.forename: Denise
authors.initials: D
authors.lastname: Keegan
authors.forename: Kathryn
authors.initials: K
authors.lastname: Byrne
authors.forename: Hugh E
authors.initials: HE
authors.lastname: Mulcahy
authors.forename: Garret
authors.initials: G
authors.lastname: Cullen
authors.forename: Dermot E
authors.initials: DE
authors.lastname: Malone
authors.forename: Glen A
authors.initials: GA
authors.lastname: Doherty
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small / Q000187:drug effects* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D007494:Ireland; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha