Combined therapy with early initiation of infliximab following drainage of perianal fistulising Crohn’s disease: a retrospective cohort study

Abstract

Background Recent studies have confirmed that combined surgery and anti-TNF therapy could improve outcomes in patients with perianal fistulising Crohn’s disease (PFCD). However, the optimal timing for infliximab infusion after surgical intervention is uncertain. We aimed to determine the long-term efficacy of early initiation of infliximab following surgery among PFCD patients. Methods We performed a retrospective cohort study of PFCD patients who received combined infliximab and surgical treatment between 2010 and 2018 at a tertiary referral hospital. Patients were grouped according to the time interval between surgery and infliximab infusion, with < 6 weeks into early infliximab induction group and > 6 weeks into delayed infliximab induction group. The primary outcome was to compare surgical re-intervention between early and delayed infliximab induction groups. The secondary outcomes were fistula healing and predictors associated with these outcomes of early infliximab induction approach. Results One hundred and seventeen patients were included (73 in early infliximab induction, 44 in delayed infliximab induction). The median interval between surgery and infliximab initiation was 9.0 (IQR 5.5–17.0) days in early infliximab induction group and 188.0 (IQR 102.25–455.75) days in delayed infliximab induction group. After followed-up for a median of 36 months, 61.6% of patients in early infliximab induction group and 65.9% in delayed infliximab induction group attained fistula healing (p = 0.643). The cumulative re-intervention rate was 23%, 32%, 34% in early infliximab induction group and 16%, 25%, 25% in delayed infliximab induction group, at 1, 2, and 3 years respectively (p = 0.235). Presence of abscess at baseline (HR = 5.283; 95% CI, 1.61–17.335; p = 0.006) and infliximab maintenance therapy > 3 infusions (HR = 3.691; 95% CI, 1.233–11.051; p = 0.02) were associated with re-intervention in early infliximab induction group. Presence of abscess at baseline also negatively influenced fistula healing (HR = 3.429, 95% CI, 1.216–9.668; p = 0.02). Conclusion Although no clear benefit was shown compared with delayed infliximab induction group, early initiation of infliximab after surgery could achieve promising results for PFCD patients. Before infliximab infusion, durable drainage is required for patients with concomitant abscess or prolonged infliximab maintenance therapy.

Comparison of endoscopic healing and durability between infliximab originator and CT-P13 in pediatric patients with inflammatory bowel disease

“…CD, Crohn's disease; CRP, C-reactive protein; CSFR, corticosteroid-free remission; ESR, erythrocyte sedimentation rate; FC, fecal calprotectin; IFX, infliximab; IQR, interquartile range; MINI, Mucosal Inflammation Non-invasive index; PCDAI, Pediatric Crohn's Disease Activity Index; SES-CD, Simple Endoscopic Score for Crohn's Disease; WBC, white blood cell count. the higher rate of combination therapy with immunomodulators in the present study(47)(48)(49)(50). In the present study, the proportions of combination therapy were 72.2% (184/255) in the IFX originator group and 82.6% (133/161) in the CT-P13 group, compared with 34.8% (8/23) and 53.6% (15/28), respectively, in the previous study.…”

“…In the present study, the proportions of combination therapy were 72.2% (184/255) in the IFX originator group and 82.6% (133/161) in the CT-P13 group, compared with 34.8% (8/23) and 53.6% (15/28), respectively, in the previous study. Furthermore, a large proportion of the patients in the present study had an early initiation of IFX strategy ( 49 ). In the present study, the median times from diagnosis to IFX initiation were 0.27 years in the IFX originator group and 0.23 years in the CT-P13 group for patients with CD and 0.77 years and 0.73 years for patients with UC, respectively.…”

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

“…Of these, 166 were included in the full text review. Seventy‐six were further excluded, leaving 90 studies for data extraction [17–106] (Figure 1). Of the 90 studies, there were 53 retrospective studies, 16 prospective observational studies, 16 RCTs, four case series and one cross‐sectional study.…”

The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials

“…The results regarding complete remission and fistula or abscess recurrence were not different between the early and delayed groups [ 56 ]. Recently, a cohort of 117 patients confirmed that the early duction of infliximab after surgery could achieve a fistula healing rate and re-intervention rate comparable to a delayed induction [ 57 ]. Thus, the early initiation of anti-TNF is preferred over delayed therapy to prevent consequent complications from fistulas.…”