Intensive versus standard drug therapy for symptomatic Crohn's disease strictures (STRIDENT)

The Lancet: Gastroenterology & HepatologyScott Cunningham MD PhD, et al. | May 02, 2022

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Early, intense chemoprevention may prevent or slow fibrostenosis in patients with CD.  Given the costs and potential surgical complications, all safe and effective preventive and therapeutic measures should be utilized. 

Seventy-seven patients with CD and an intestinal stricture based on imaging, colonoscopy, and/or symptoms were enrolled in this single-center, randomized controlled trial. 

Patients received adalimumab (n=52; 160 mg/w x 4w, then 40 mg q2w with escalation at 4 and 8 months based on disease activity) plus thiopurine (azathioprine [2.5 mg/kg] or mercaptopurine [1.5 mg/kg]) or adalimumab monotherapy (n=25; 160 mg at week 0, 80 mg at week 2, then 40 mg q2w). 

The primary outcome measure was improvement in the 14-d obstructive symptom score at 12 months.

Forty-one of 52 patients (79%) in the adalimumab plus thiopurine group and 16 of 25 patients (64%) in the adalimumab monotherapy group had improvement in the 14-d obstructive symptom score at 12 months. 

Five (10%) and 7 (28%) patients had treatment failure in the combined and monotherapy groups, respectively.  Four patients underwent stricture surgery in each group. 

Notably, 10 (20%) and 4 (16%) patients were stricture-free based on MRI.  Thirty-two (62%) and 11 (44%) patients had normal CRP levels at study end.

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