Deep remission on magnetic resonance imaging impacts outcomes of perianal fistulizing Crohn's disease.
Adalimumab
/ therapeutic use
Adolescent
Adult
Aged
Antibodies, Monoclonal
/ therapeutic use
Crohn Disease
/ diagnostic imaging
Disease-Free Survival
Female
Gastrointestinal Agents
/ therapeutic use
Hospitalization
/ statistics & numerical data
Humans
Infliximab
/ therapeutic use
Kaplan-Meier Estimate
Magnetic Resonance Imaging
Male
Middle Aged
Perineum
/ surgery
Rectal Fistula
/ diagnostic imaging
Retrospective Studies
Tertiary Care Centers
Treatment Outcome
Tumor Necrosis Factor-alpha
/ antagonists & inhibitors
Young Adult
Anal fistula
Anti-TNF- α
Crohn’s disease
Magnetic resonance imaging
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
24
07
2018
revised:
11
12
2018
accepted:
12
12
2018
pubmed:
8
1
2019
medline:
19
9
2019
entrez:
8
1
2019
Statut:
ppublish
Résumé
The long-term management of perianal Crohn's disease for patients on anti-TNF-α therapy remains challenging. To evaluate the long-term course and complications of patients with perianal fistulas treated with anti-TNF-α based on their clinical remission and healing on MRI. Patients were evaluated clinically and by MRI. Deep remission was defined as clinical remission associated with the absence of contrast enhancement and T2 hyperintensity on MRI. Flare-free survival, surgery and hospitalizations were compared based on the presence or not of deep remission. Forty-eight consecutive patients were included with a median follow-up of 62 months after anti-TNF-α first administration. Deep remission was observed in 16 patients (33.4%). For patients in deep remission, the median time to any perianal event was 116 months (95-130) versus 42 months (8-72) in patients with pathological MRI (p < 0.001). Sixteen patients (50%) with pathological MRI had perianal surgery versus 2 (12.5%) in the deep remission group (p < 0.05). The mean duration of cumulative hospital stays was 0.75 ± 0.52 days in the deep remission group versus 19.7 ± 7.4 in the pathological group (p < 0.05). Higher flare-free survival and lower rates of surgery and hospitalization were found in patients achieving deep remission.
Sections du résumé
BACKGROUND
The long-term management of perianal Crohn's disease for patients on anti-TNF-α therapy remains challenging.
AIM
To evaluate the long-term course and complications of patients with perianal fistulas treated with anti-TNF-α based on their clinical remission and healing on MRI.
METHODS
Patients were evaluated clinically and by MRI. Deep remission was defined as clinical remission associated with the absence of contrast enhancement and T2 hyperintensity on MRI. Flare-free survival, surgery and hospitalizations were compared based on the presence or not of deep remission.
RESULTS
Forty-eight consecutive patients were included with a median follow-up of 62 months after anti-TNF-α first administration. Deep remission was observed in 16 patients (33.4%). For patients in deep remission, the median time to any perianal event was 116 months (95-130) versus 42 months (8-72) in patients with pathological MRI (p < 0.001). Sixteen patients (50%) with pathological MRI had perianal surgery versus 2 (12.5%) in the deep remission group (p < 0.05). The mean duration of cumulative hospital stays was 0.75 ± 0.52 days in the deep remission group versus 19.7 ± 7.4 in the pathological group (p < 0.05).
CONCLUSIONS
Higher flare-free survival and lower rates of surgery and hospitalization were found in patients achieving deep remission.
Identifiants
pubmed: 30612820
pii: S1590-8658(18)31305-7
doi: 10.1016/j.dld.2018.12.010
pii:
doi:
Substances chimiques
Antibodies, Monoclonal
0
Gastrointestinal Agents
0
Tumor Necrosis Factor-alpha
0
Infliximab
B72HH48FLU
Adalimumab
FYS6T7F842
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
358-363Informations de copyright
Copyright © 2018. Published by Elsevier Ltd.