Higher Anti-tumor Necrosis Factor-alpha Levels Correlate With Improved Radiologic Outcomes in Crohn&#39;s Perianal Fistulas

De Gregorio, M; Lee, T; Krishnaprasad, K; Amos, G; An, YK; Bastian-Jordan, M; Begun, J; Borok, N; Brown, DJM; Cheung, W; Connor, SJ; Gerstenmaier, J; Gilbert, LE; Gilmore, R; Gu, B; Kutaiba, N; Lee, A; Mahy, G; Srinivasan, A; Thin, L; Thompson, AJ; Welman, CJ; Yong, EXZ; De Cruz, P; van Langenberg, D; Sparrow, MP; Ding, NS

Higher Anti-tumor Necrosis Factor-alpha Levels Correlate With Improved Radiologic Outcomes in Crohn's Perianal Fistulas

Author(s): De Gregorio, M; Lee, T; Krishnaprasad, K; Amos, G; An, YK; Bastian-Jordan, M; Begun, J; Borok, N; Brown, DJM; Cheung, W; Connor, SJ; Gerstenmaier, J; Gilbert, LE; Gilmore, R; Gu, B; Kutaiba, N; Lee, A; Mahy, G; Srinivasan, A; Thin, L; Thompson, AJ; Welman, CJ; Yong, EXZ; De Cruz, P; van Langenberg, D; Sparrow, MP; Ding, NS;
Details: Publication Year 2022-06,Volume 20,Issue #6,Page 1306-1314
Journal Title: Clinical Gastroenterology and Hepatology
Publication Type: Research article
Abstract: BACKGROUND & AIMS: Higher anti-tumor necrosis factor-alpha (TNF) drug levels are associated with improved clinical healing of Crohn's perianal fistulas. It is unclear whether this leads to improved healing on radiologic assessment. We aimed to evaluate the association between anti-TNF drug levels and radiologic outcomes in perianal fistulising Crohn's disease. METHODS: A cross-sectional retrospective multicenter study was undertaken. Patients with perianal fistulising Crohn's disease on maintenance infliximab or adalimumab, with drug levels within 6 months of perianal magnetic resonance imaging were included. Patients receiving dose changes or fistula surgery between drug level and imaging were excluded. 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, rectal wall involvement. Primary endpoint was radiologic healing (inflammatory subscore </=6). Secondary endpoint was radiologic remission (inflammatory subscore = 0). RESULTS: Of 193 patients (infliximab, n = 117; adalimumab, n = 76), patients with radiologic healing had higher median drug levels compared with those with active disease (infliximab 6.0 vs 3.9 mug/mL; adalimumab 9.1 vs 6.2 mug/mL; both P < .05). Patients with radiologic remission also had higher median drug levels compared with those with active disease (infliximab 7.4 vs 3.9 mug/mL; P < .05; adalimumab 9.8 vs 6.2 mug/mL; P = .07). There was a significant incremental reduction in median inflammatory subscores with higher anti-TNF drug level tertiles. CONCLUSIONS: Higher anti-TNF drug levels were associated with improved radiologic outcomes on magnetic resonance imaging in perianal fistulising Crohn's disease, with an incremental improvement at higher drug level tertiles for both infliximab and adalimumab.
Keywords: Adalimumab/therapeutic use; *Crohn Disease/complications/diagnostic imaging/drug therapy; Cross-Sectional Studies; Humans; Infliximab/therapeutic use; *Rectal Fistula/diagnostic imaging/drug therapy; Retrospective Studies; Treatment Outcome; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alpha; Anti-TNF; Crohn's Perianal Fistula; Magnetic Resonance Imaging; Therapeutic Drug Monitoring
Department(s): Cancer Imaging
PubMed ID: 34389484
Publisher's Version: https://doi.org/10.1016/j.cgh.2021.07.053
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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