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

The Lancet: Gastroenterology & Hepatology May 03, 2022

Why this study matters

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. 

Study design

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.

Results and conclusion

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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