In patients with Crohn’s disease complicated by symptomatic intestinal strictures, the anti-tumor necrosis factor (TNF) agents are effective in approximately a quarter of patients. The response may be substantially improved by the early introduction of this treatment.

In the long-term (after a median follow-up of 40 months), about 68% of patients are able to avoid intestinal surgery. Early treatment and some potential predictors of response were found to be linked with treatment success in this setting.

A multicentric retrospective study was conducted to characterize the effectiveness of first-line anti-TNF agents in Crohn’s disease complicated by symptomatic intestinal strictures in a real-world setting.

The study recruited 262 adult patients with symptomatic stricturing Crohn’s disease (53% male; median disease duration, 35 months,15% active smokers) with no previous history of biological, endoscopic, or surgical therapy. From 32 hospitals in Spain, participants receiving their first anti-TNF therapy between October 2001 and July 2018 were enrolled in this analysis.

The effectiveness of the anti-TNF agent was the primary outcome and was defined as a composite outcome combining the steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery, or endoscopic therapy during the follow-up.

Participants were allocated to either infliximab (n=141, 54%) group or adalimumab (n=121, 46%) group. The percentage of patients in which the treatment was effective after six and 12 months, is depicted in the following table:

After a median follow-up of 40 months, the treatment was found to be effective in 68% (n=26) of patients. The Kaplan–Meier estimate of the effectiveness of anti-TNF therapy during follow-up is shown in the following figure:

The percentage of patients requiring surgery is illustrated in the following table:

The Kaplan–Meier estimate of surgery rates during follow-up is depicted in the following figure:

In 15% of patients, the postoperative complications were detected with surgical site infection as the most common.  Initiating anti-TNF therapy early (in the first 18 months) after the diagnosis of Crohn’s disease or the identification of stricturing complications was linked with greater effectiveness, as shown in the following table:

Reduced albumin levels, younger age, strictures located in the descending colon, concomitant aminosalicylates use, or presence of lymphadenopathy were considerably linked with lower effectiveness.

The main outcomes in patients receiving anti-TNF therapy, including anti-TNF drug survival, hospital admission, switch, surgery, use of new immunomodulators, or endoscopic therapy are depicted in the following figure:

A high proportion of patients with Crohn’s disease with symptomatic intestinal stricturing lesions benefit from anti-TNF therapy. TNF antagonists can improve the outcomes of such patients but timely intervention appears to be an important factor.