Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

Adler, Jeremy; Lin, Chun Chieh; Gadepalli, Samir K.; Dombkowski, Kevin J.

doi:10.1001/jamanetworkopen.2020.7378

Cited by 29 publications

(24 citation statements)

References 53 publications

(120 reference statements)

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“…3 Seton treatment should not be recommended as the sole treatment for perianal Crohn's fistulas. 25 In contrast, the use of immunomodulators alone and anti-TNFα alone reduced the risk of PCD development after 2 years by 52% and 47%, 26 respectively. Our study showed that biological therapy concomitant with perianal intervention could significantly decrease fistula recurrence in perianal CD patients compared with conventional medication with surgery.…”

Section: Discussionmentioning

confidence: 99%

Perianal and Luminal Relapse Following Perianal Surgical Intervention in Crohn’s Disease

Deng

Xia

et al. 2021

IJGM

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Background and Aims: Fistula relapse occurs in 20-30% of patients with perianal Crohn's disease (PCD) despite optimal medico-surgical management. We aimed in this study to assess the rate of perianal and luminal relapse after surgically induced remission and to determine factors associated with fistula relapse. Methods: Consecutive perianal CD patients who achieved clinical remission after surgery for fistulising PCD from January 2013 to January 2019 were included. The cumulative probabilities of relapse-free survival were estimated using the Kaplan-Meier method. Results: A total of 130 patients were included. Sixty-six of 130 patients received infliximab (IFX) therapy after perianal surgery. After a median follow-up of 62 months (interquartile range [IQR]: 28-117 months), perianal relapse occurred in 30 of 64 (46.9%) nonbiological medication-treated cases and in 14 of 66 (21.1%) cases in the IFX therapy group. The cumulative probabilities of perianal relapse-free survival in patients with nonbiological treatment were 77.1% at 1 year, 54.6% at 3 years, and 30% at 5 years. The rates of survival without perianal fistula relapse in the IFX-treated group were 91.6%, 69.2%, and 59.3% at 1, 3 and 5 years, respectively. In patients treated with IFX after perianal surgery, discontinuation of IFX therapy (odds ratio [OR]=2.43, p=0.036), a penetrating CD phenotype (OR=4.324, p=0.019), and a complex perianal fistula (OR=3.392, p=0.026) were independently associated with perianal relapse in multivariate analysis. Conclusion: Infliximab therapy reduced the risk of perianal relapse after surgical remission in PCD patients compared with nonbiological treatment. However, approximately 40% of patients using infliximab experienced perianal relapse at 5 years, and patients who discontinued use of IFX or experienced a penetrating phenotype or a complex perianal fistula were associated with increased relapse rate.

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Section: Discussionmentioning

confidence: 99%

Perianal and Luminal Relapse Following Perianal Surgical Intervention in Crohn’s Disease

Deng

Xia

et al. 2021

IJGM

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“…En Asia se reportó una probabilidad acumulada de uso de esteroides del 25-44% (22,40) . Estas cifras elevadas en el uso de corticoides estarían en relación a su rápido control sobre la enfermedad activa (41) , y el descenso progresivo durante el mantenimiento, como en nuestra serie, responde a que existe un mayor conocimiento de los efectos adversos, lo que exige buscar alternativas más seguras y efectivas (42,43) . Es preciso señalar que, algunos pacientes que mantuvieron el uso de corticoides correspondieron a nuestros primeros casos, considerados corticodependientes y en este periodo, antes del 2010, no estaba disponible la terapia biológica en la institución.…”

Section: Discussionunclassified

Epidemiología y fenotipo de la enfermedad de Crohn en un hospital de referencia en Lima - Perú

Méndez

Sandoval

Marcacuzco

et al. 2020

Rev Gastroenterol Peru

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La enfermedad de Crohn (EC) es una patología inflamatoria crónica del tracto digestivo con gran impacto en la calidad de vida de los pacientes. La epidemiología mundial está cambiando en los últimos años y su prevalencia está aumentando en Latinoamérica. Objetivo: Evaluar las características epidemiológicas, fenotipo, curso clínico, diagnóstico y tratamiento de la EC. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo de pacientes con diagnóstico de EC desdeenero 2004 a diciembre 2019 en el servicio de gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, Lima-Perú. Resultados: Se incluyó 55 pacientes, con edad promedio de 56 ± 8,2 años. Predominio masculino (62%). El tiempo promedio de diagnóstico fue de 18 ± 6,1 meses. Los síntomas más frecuentes fueron: dolor abdominal 72,7% y baja de peso 60%. Las manifestaciones extraintestinales se presentaron en 20%. La localización ileal (36,4%) fue la más frecuente,seguida de la colónica (32,7%). Predominó el fenotipo inflamatorio en la mitad de los pacientes, seguido de estenosante en 25,5%. La actividad clínica y endoscópica más frecuente fue moderada. Para el tratamiento de inducción y mantenimiento, los corticoides sistémicos y la terapia biológica con anti-TNF fueron los más utilizados respectivamente. Aproximadamente un tercio de pacientes requirieron cirugía durante la evolución de la enfermedad. La mortalidad fue del 5,4%. Conclusiones: La EC es una enfermedad cada vez más frecuente en nuestro país, con características epidemiológicas y fenotípicas que difierende otros continentes.

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“…A retrospective claims-based study evaluated the role of early use of immunosuppressive therapies in reducing the risk of developing future perianal disease amongst individuals with a new diagnosis of Crohn’s disease. In this study, individuals with a new diagnosis of Crohn’s disease without perianal disease exposed to at least 90 days of immunosuppressants or anti-TNF therapy had a 59% reduction in risk, compared to those not using these agents, of developing symptomatic perianal disease over 2 years[ 16 ]. While these results require further validation, this study raises the possibility that individuals who are identified as having perianal disease may benefit from earlier medical therapy with immunosuppressive or anti-TNF therapy even if they are minimally symptomatic.…”

Section: When Is the Best Time To Commence Anti-tnf Therapy In Perianal Crohn’s Disease?mentioning

confidence: 99%

Approach to medical therapy in perianal Crohn’s disease

Vasudevan¹,

Loftus²,

Faubion³

et al. 2021

WJG

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Perianal Crohn’s disease remains a challenging condition to treat and can have a substantial negative impact on quality of life. It often requires combined surgical and medical interventions. Anti-tumor necrosis factor (anti-TNF) therapy, including infliximab and adalimumab, remain preferred medical therapies for perianal Crohn’s disease. Infliximab has been shown to be efficacious in improving fistula closure rates in randomized controlled trials. Clinicians can be faced with a number of questions relating to the optimal use of anti-TNF therapy in perianal Crohn’s disease. Specific issues include evaluation for the presence of perianal sepsis, the treatment target of therapy, the ideal time to commence treatment, whether additional medical therapy should be used in conjunction with anti-TNF therapy, and the duration of treatment. This article will discuss key studies which can assist clinicians in addressing these matters when they are considering or have already commenced anti-TNF therapy for the treatment of perianal Crohn’s disease. It will also discuss current evidence regarding the use of vedolizumab and ustekinumab in patients who are failing to achieve a response to anti-TNF therapy for perianal Crohn’s disease. Lastly, new therapies such as local injection of mesenchymal stem cell therapy will be discussed.

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Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

Cited by 29 publications

References 53 publications

Perianal and Luminal Relapse Following Perianal Surgical Intervention in Crohn’s Disease

Perianal and Luminal Relapse Following Perianal Surgical Intervention in Crohn’s Disease

Epidemiología y fenotipo de la enfermedad de Crohn en un hospital de referencia en Lima - Perú

Approach to medical therapy in perianal Crohn’s disease

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