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Title: Higher Anti-tumor Necrosis Factor-α Levels Correlate With Improved Radiologic Outcomes in Crohn's Perianal Fistulas.
Austin Authors: De Gregorio, Michael;Lee, Tanya;Krishnaprasad, Krupa;Amos, Gregory;An, Yoon-Kyo;Bastian-Jordan, Matthew;Begun, Jakob;Borok, Nira;Brown, Dougal J M;Cheung, Wa;Connor, Susan J;Gerstenmaier, Jan;Gilbert, Lauren E;Gilmore, Robert B ;Gu, Bonita;Kutaiba, Numan ;Lee, Allan;Mahy, Gillian;Srinivasan, Ashish ;Thin, Lena;Thompson, Alexander J;Welman, Christopher J;Yong, Eric X Z;De Cruz, Peter P ;van Langenberg, Daniel;Sparrow, Miles P;Ding, Nik S
Affiliation: Gastroenterology and Hepatology
Ingham Institute for Applied Medical Research, Medicine, Liverpool, Australia..
Alfred Health, Medical Imaging, Melbourne, Australia..
Alfred Health, Gastroenterology, Melbourne, Australia..
Liverpool Hospital, Medical Imaging, Liverpool, Australia..
Liverpool Hospital, Gastroenterology and Hepatology, Liverpool, Australia..
University of New South Wales, South Western Sydney Clinical School, Sydney, Australia..
Royal Prince Alfred Hospital, Gastroenterology and Hepatology, Camperdown, Australia..
Eastern Health, Gastroenterology, Box Hill, Australia..
Eastern Health, Radiology, Box Hill, Australia..
Imaging Associates Eastern Health, Medical Imaging, Melbourne, Australia..
Peter MacCallum Cancer Centre, Cancer Imaging, Melbourne, Australia..
Townsville University Hospital, Gastroenterology, Douglas, Australia..
Townsville University Hospital, Medical Imaging, Douglas, Australia..
Monash University, Medicine, Clayton, Australia..
Fiona Stanley Hospital, Gastroenterology, Murdoch, Australia..
Fiona Stanley Hospital, Medical Imaging, Murdoch, Australia..
St Vincent's Hospital Melbourne, Medical Imaging, Fitzroy, Australia..
St Vincent's Hospital Melbourne, Department of Gastroenterology, Fitzroy, Australia..
University of Melbourne, Medicine, Parkville, Australia..
University of Western Australia, School of Medicine and Pharmacology, Crawley, Australia..
QIMR Berghofer Medical Research Institute, Gut Health Lab, Brisbane, Australia..
University of Queensland, Medicine, St Lucia, Australia..
Mater Hospital Brisbane, Gastroenterology, South Brisbane, Australia..
Queensland X-ray, Medical Imaging, Brisbane, Australia..
University of Queensland, Mater Research Institute, St Lucia, Australia..
South Western Sydney Local Health District, Medicine, Liverpool, Australia..
Issue Date: Jun-2022
Date: 2021-08-11
Publication information: Clinical gastroenterology and hepatology 2022; 20(6): 1306-1314
Abstract: Higher anti-tumor necrosis factor-α (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. 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). 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 μg/mL; adalimumab 9.1 vs 6.2 μg/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 μg/mL; P < .05; adalimumab 9.8 vs 6.2 μg/mL; P = .07). There was a significant incremental reduction in median inflammatory subscores with higher anti-TNF drug level tertiles. 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.
DOI: 10.1016/j.cgh.2021.07.053
ORCID: 0000-0002-3399-7236
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
PubMed URL: 34389484
PubMed URL:
Type: Journal Article
Subjects: Anti-TNF
Crohn’s Perianal Fistula
Magnetic Resonance Imaging
Therapeutic Drug Monitoring
Appears in Collections:Journal articles

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