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EUS accurately detects early response with Humira in active ulcerative colitis

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WASHINGTON — Endoscopic ultrasound reliably evaluated early response in patients with active ulcerative colitis following treatment with Humira, and shows promise as a potential diagnostic tool, according to data presented at Digestive Disease Week.

“The aim of our study was to evaluate the use of EUS of the colonic wall in patients with active UC undergoing treatment with the anti-TNF antibody adalimumab,” Mark Ellrichmann, MD, from University Hospital Schleswig-Holstein, Germany, said in a presentation. “We tried to exactly quantify the level of inflammation just by endoscopic means, and we tried to predict the early response to this TNF-alpha antibody.”

Mark Ellrichmann

To evaluate the utility of EUS of the sigmoid colon for detecting early response in active ulcerative colitis patients after Humira (adalimumab, AbbVie) therapy, Ellrichmann and colleagues examined 36 patients with active ulcerative colitis and 20 healthy controls undergoing screening colonoscopy. The patients were examined before initiation of therapy and 1, 4 and 12 weeks after, and mucosal, submucosal and total wall-thickness (TWT) were measured. The investigators examined gut wall vascularity using dynamic contrast enhanced EUS, and quantified contrast kinetics as time to peak intensity (TTP).

They found a TWT of 1.8 ± 0.03 mm in the healthy controls and layers were clearly differentiated, while patients with active ulcerative colitis had TWT of 3.91 ± 0.21 mm (P < 0.001). Among the 72% of ulcerative colitis patients with clinical response to adalimumab therapy, TWT was 27.7% lower (2.5 ± 0.2 mm; P = 0.007) within 1 week compared with baseline, and after 4 weeks these levels reduced even further (2.2 ± 0.2 mm). Adalimumab nonresponders did not have significant changes in TWT after 1 and 3 weeks.

The healthy controls had 13.1 ± 1.3 seconds TTP compared with 6.8 ± 0.7 seconds in active ulcerative colitis patients (P = 0.0005). TTP normalized in responders within 1 week (9.9 ± 0.8 seconds; P = 0.008) compared with baseline, while no change in TTP were observed in nonresponders.

TWT and Mayo scores strongly correlated before adalimumab therapy, while no correlation was observed 1 week after therapy (P > 0.05), and throughout the course of therapy there was a positive relation between TWT and histological inflammation scores (r=0.65; P < 0.001).

“EUS of the colon provides a reliable quantification of the grade of inflammation n UC. The combination of TWT and contrast-enhanced ultrasound can be used as a marker of early response during TNF alpha antibody therapy and can possibly be used as a marker of nonresponse.”  – by Adam Leitenberger 

For more information:

Ellrichmann M. Abstract 210. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.

Disclosure: Ellrichmann reports no relevant financial disclosures. Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.