Background: Strictures, a common complication of Crohn's disease, have traditionally been treated with surgery or endoscopic balloon dilation, with drug therapy considered contraindicated. However, a recent study aimed to explore the effectiveness of drug treatment for these strictures, given their inflammatory component.
Methods: The study was an open-label, single-centre, randomised controlled trial conducted in Australia. It included patients aged 18 years or older with Crohn's disease, who had a de novo or postoperative anastomotic intestinal stricture and symptoms of chronic or subacute intestinal obstruction. Patients were randomly assigned to receive either intensive high-dose adalimumab plus thiopurine or standard adalimumab monotherapy.
Findings: At 12 months, 79% of patients in the intensive treatment group showed improvement in obstructive symptom scores, compared to 64% in the standard treatment group. Treatment failure was lower in the intensive group (10%) than in the standard group (28%). MRI and intestinal ultrasound showed greater improvement in stricture morphology in the intensive treatment group. Serious adverse events were reported by 15% of patients in the intensive group and 16% in the standard group, with no deaths occurring during the study.
Interpretation: The study concluded that Crohn's disease strictures are responsive to drug treatment, with most patients experiencing improved symptoms and stricture morphology. Intensive treat-to-target therapy resulted in less treatment failure and greater improvement in stricture morphology, although these differences were not significantly different from standard therapy.
