The long-term results of the STRIDENT study demonstrated that an intensified treatment regimen results in less inflammation, a reduced treatment failure, and better Crohn’s disease (CD) stricture morphology. Participants with a clinical response at 12 months were less likely to undergo surgery at 24 months.
Is there a long-term benefit of an intensified regimen for strictures in CD and the need for surgery? To answer this question, the randomised-controlled STRIDENT study (NCT03220841) was performed. Previous results of the STRIDENT trial showed that CD symptomatic strictures respond to anti-TNF therapy: most participants clinically improved after a 12-month treatment with an intensified treat-to-target regimen of adalimumab +/- thiopurines . Dr Julien Schulberg (St Vincent’s Hospital Melbourne, Australia) presented the 2-year follow-up data that assessed the response durability and risk of surgery .
In the study, participants were randomised to receive a high dose adalimumab induction, 160 mg weekly for 4 weeks, followed by 40 mg fortnightly 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 the participants in the intensive arm compared with 64% in the standard arm (P=0.17). “The majority of patients had symptomatic improvement, and improvement was more likely in the intense treatment arm,” Dr Schulberg said. In addition, fewer participants in the intense-treatment arm had a treatment failure at 12 months.
Between 12 and 24 months, only 3 patients ceased adalimumab in the intensive arm but 13 decreased the dose. In the first 12 months, 9% of participants had surgery and a further 10% in the next 12 months. Notably, participants with a clinical response at 12 months were less likely to have surgery at 2 years (9% vs 42%; P=0.003). However, the total rates of surgery were not different between the standard and intensive therapy arms at 2 years (see Figure).
Figure: No difference in total rates of surgery over 24 months between intensified and standard treatment 
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.
- Schulberg JD, et al. Lancet Gastroenterol Hepatol. 2022;7(4):318–331.
- Schulberg J, et al. Crohn’s Disease Strictures Respond to Drug Treatment and Treat-to-Target Intense Combination Therapy is More Effective than Standard Anti-TNF Therapy. Two-year results of the STRIDENT Randomised Controlled Trial. DOP85, ECCO 2023, 1–4 March, Copenhagen, Denmark.
« Continued efficacy of long-term ozanimod as UC treatment Next Article
Anti-TNF withdrawal may be a safe option in stable IBD »
Table of Contents: ECCO 2023
Letter from the Editor
ECCO 2023 Highlights Podcast
What Is New in Biologic Therapy?
Beneficial effect of early, post-operative vedolizumab on endoscopic recurrence in CD
Long-term data supports the established efficacy and safety of ustekinumab in UC
Anti-TNF withdrawal may be a safe option in stable IBD
Intensified drug therapy leads to better stricture morphology in CD
Small Molecules in IBD: State of the Art
Continued efficacy of long-term ozanimod as UC treatment
Upadacitinib successful in the management of both CD and UC
Solid results for long-term therapy of UC with filgotinib
Paediatric IBD: What You Need To Know
Perinatal period is crucial for the risk of developing CD
Early-life antibiotic exposure: a risk factor for paediatric-onset IBD
Paediatric patients with immune-mediated inflammatory disease harbour a heightened cancer risk
Risk Factors and Complications of IBD
Checking kidney function is important during the course of IBD
Diabetes therapy with GLP-1-based drugs does not elevate the risk of IBD
Surgical Approaches: New Developments
Long-term resection potentially better than anti-TNF treatment in CD
Early, post-operative complications in CD reduced by pre-operative enteral nutrition, irrespective of biologic exposure
Pearls of the Posters
Drop in overall IBD procedures during the pandemic
Proton pump inhibitors associated with worse outcomes in CD
Poor sleep in CD linked to low levels of vitamin D
Novel AI tool assessing mucosal inflammation achieves high correlation with histopathologists