An intensified treatment regimen reduced treatment failure and improved CD stricture morphology but didn’t impact rates of surgery at 2 years.

The aim of the randomized STRIDENT study was to assess the response of CD strictures to drug therapy and to determine the optimal treatment regimen. Previously, it could be shown that symptomatic CD strictures are responsive to anti-TNF therapy; most patients clinically improved after a 12-month treatment with an intensified treat-to-target regimen of adalimumab +/- thiopurines. This year, Dr. Julien Schulberg of St Vincent’s Hospital in Melbourne and his team presented 2-year data from the STRIDENT trial.

In the study, patients were randomized either to receive a high dose adalimumab induction (160 mg weekly for 4 weeks) followed by 40 mg every 2 weeks plus thiopurine, with an adalimumab dose increase at 4 and/or 8 months if there was evidence of ongoing inflammation (N=52), or standard dose adalimumab monotherapy (N=25).

The primary study endpoint was the obstructive symptoms score (OSS) at 12 months. This endpoint was achieved by 79% of patients in the intensive arm compared with 64% in the standard arm. “The majority of patients had symptomatic improvement and improvement was more likely in the intense treatment arm,” Dr. Schulberg said. In addition, fewer patients had treatment failure at 12 months in the intense treatment arm.

Between 12 and 24 months, only three patients in the intensive arm stopped adalimumab, but 13 decreased the dose. In the first 12 months, 9% of patients had surgery, and a further 10% in the next 12 months. Of note, patients with a clinical response at 12 months were less likely to have surgery at 2 years (9% vs 42%; P=0.003). However, rates of surgery were not different between the standard and intensive therapy arms at 2 years.

Dr Schulberg concluded that most CD strictures are responsive to drug treatment. Intense treat-to-target treatment results in reduced treatment failure, less inflammation, and better stricture morphology. Moreover, stricture bowl damage is often reversible, with 20% of patients achieving objective complete stricture resolution.

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