Intestinal ultrasound may predict Stelara response at 1 year in Crohn’s disease
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Key takeaways:
- Changes from induction to week 24 in bowel wall thickness and Limberg score, among others, correlated with endoscopic response.
- An IUS score based on these parameters was “highly accurate” in predicting response.
Multimodal intestinal ultrasound performed at 24 weeks can provide “useful information” for predicting endoscopic response at 1 year in patients with active Crohn’s disease initiating treatment with Stelara, according to researchers.
“Intestinal ultrasound (IUS) is gaining a growing interest due to its large availability, noninvasivity, cost-effectiveness and high accuracy in detecting transmural disease activity,” Maria Elena Ainora, MD, PhD, of Catholic University of the Sacred Heart in Rome, and colleagues wrote in Therapeutic Advances in Gastroenterology. “Different trials and meta-analyses showed that IUS is equally sensitive and specific as CT and MRI in diagnosis and follow-up of CD.”
They continued: “However, this technique is not yet standardized and its role in the evaluation of inflammation remains controversial.”
In a prospective, monocentric study, researchers investigated the value of multimodal IUS in predicting Stelara (ustekinumab, Janssen) response among 52 patients (mean age, 50 years; 57.7% men) with active ileal or ileocolonic CD, who previously received anti-tumor necrosis factor-alpha.
Participants were enrolled between January 2020 and October 2021 and underwent complete IUS evaluation, which included B-mode, Doppler, dynamic contrast-enhanced and elastography ultrasound, at the time of ustekinumab induction and at weeks 8, 16, 24 and 48 of treatment.
Results at 48 weeks showed 55.8% of patients achieved endoscopic response and 32.7% obtained mucosal healing.
According to univariate analysis, from induction to 24 weeks the percentage reduction in bowel wall thickness (OR = 0.95; 95% CI, 0.92-0.99) correlated with endoscopic response, as did changes in Limberg score (OR = 0.96; 95% CI, 0.93-0.99), mean signal intensity (OR = 0.98; 95% CI, 0.97-0.99), wash-in rate (OR = 0.97; 95% CI, 0.96-0.99) and Harvey–Bradshaw Index (OR = 0.95; 95% CI, 0.91-0.98) as well as increase of rise time (OR = 1.04; 95% CI, 1.02-1.07). Researchers also noted a “more evident decrease” during this time in shear wave elastography in responders vs. non-responders (–25.7 vs. –4.2).
Ainora and colleagues used three independent predictors — male sex, percentage change in Limberg score and percentage change in wash-in rate — to develop an IUS score that was “highly accurate” in predicting endoscopic response at 1 year, with an area under the curve of 0.91. The score exhibited similar accuracy in detecting non-responders to ustekinumab, at a cut-off point under 0.51 (96.5% sensitivity;78.3% specificity).
“In patients affected by CD undergoing biologic therapy with ustekinumab, a 24-week multiparametric IUS can provide useful information predicting 1-year endoscopic response,” Ainora and colleagues wrote. “This approach may help clinicians in the decision-making process, leading to confirm or modify therapeutic strategies, including the possibility to switch to another biological drug in case of non-response.”
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