| Original Article |
Question: What correlation exists between radiologic healing and remission as determined by perianal MRI and anti-tumor necrosis factor-α (TNF) medication levels (infliximab and adalimumab)?
Design: A cross-sectional retrospective multicenter study was conducted from 2010 to 2020. Radiologic disease activity was scored using the Van Assche Index, with an inflammatory subscore calculated using indices, T2-weighted imaging hyperintensity, collections >3 mm diameter, and rectal wall involvement. The primary endpoint was radiologic healing (inflammatory subscore ≤6). The secondary endpoint was radiologic remission (inflammatory subscore =0)
Setting: Australia and New Zealand
Patient/Study community: Patients with perianal fistulising Crohn’s disease on maintenance infliximab or adalimumab, with drug levels within 6 months of perianal magnetic resonance imaging
Results: In patients with perianal fistulizing Crohn’s disease, higher anti-TNF drug levels are related to better radiologic outcomes on magnetic resonance imaging, with an incremental improvement at higher drug level tertiles for both infliximab and adalimumab
| The details of the study results | |||
| Patients | Infliximab n=117 | adalimumab, n = 76 | P value |
| patients with radiologic healing | 6.0 mg/mL | 9.1 mg/mL | <.05 |
| Patients with active disease | 3.9 mg/mL | 6.2 mg/mL | <.05 |
| Patients with radiologic remission | 7.4 mg/mL | 9.8 mg/mL | .07 |
| Patients with active disease | 3.9 mg/mL | 6.2 mg/mL | .07 |
Commentary:
| According to the findings of this extensive study, in patients with perianal fistulizing Crohn’s disease higher anti-TNF drug levels are associated with improved MRI parameters as per the Van Assche Index. At higher anti-TNF medication level tertiles for both infliximab and adalimumab, MRI outcomes are objectively improved. These results now call for replication in prospective investigations |
Citation: Michael De Gregorio, Tanya Lee, Krupa Krishnaprasad, and et all. Higher Anti-tumor Necrosis Factor-α Levels Correlate with Improved Radiologic Outcomes in Crohn’s Perianal Fistulas. Clinical Gastroenterology and Hepatology. 2022; 20(6):1306–1314
DOI: 10.1016/j.cgh.2021.07.053
https://pubmed.ncbi.nlm.nih.gov/34389484/
Topics: Anti-TNF, Crohn’s Perianal Fistula, Magnetic Resonance Imaging, Therapeutic Drug Monitoring
