Emerging issues in the medical management of Crohnʼs disease

Targownik, Laura E.; Coneys, John Gerard; Dhillon, Amit

doi:10.1097/mog.0000000000000242

Cited by 4 publications

(2 citation statements)

References 38 publications

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“…Vedolizumab is a gut-specific anti-integrin monoclonal antibody approved for the treatment of CD and ulcerative colitis and may be beneficial in the postoperative setting given its ability to reduce leukocyte trafficking in the gut and theoretically reduce early inflammatory changes. 98 – 100 However, as of this writing, there are no studies assessing the use of vedolizumab to prevent endoscopic recurrence. FMT is currently being investigated in a clinical trial as an option for prevention of endoscopic recurrence (NCT02417974).…”

Section: Future Therapiesmentioning

confidence: 99%

Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

Campbell¹,

Vaughn²

2016

CEG

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Despite improvements in medical therapies for Crohn’s disease (CD), up to 70% of patients require surgery within 10 years of diagnosis. Surgery is not curative, and almost all patients will experience endoscopic recurrence, and many will go on to clinical recurrence. Identifying patients at high-risk of endoscopic recurrence and standardizing postoperative assessments are essential in preventing clinical recurrence of CD. In this review, we discuss the assessment, monitoring, and treatment of postoperative CD patients. We address the various individual risk factors as well as composite risk factors. Medications used for primary CD treatment can be used in the postoperative setting to prevent endoscopic or clinical recurrence with varying efficacy, although the cost-effectiveness of these approaches are not fully understood. Future directions for postoperative CD management include evaluation of newer biologic agents such as anti-integrin therapy and fecal microbiota transplant for prevention of recurrence. Development of a standard preoperative risk assessment tool to clearly stratify those at high-risk of recurrence is necessary to guide empiric therapy. Lastly, the incorporation of noninvasive testing into disease monitoring will likely lead to early detection of endoscopic recurrence that will allow for tailored treatment to prevent clinical recurrence.

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Section: Future Therapiesmentioning

confidence: 99%

Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

Campbell¹,

Vaughn²

2016

CEG

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“…This is mainly owing to lack of enough studies investigating comparative efficacy of these medicines. [2122232425]…”

Section: Introductionmentioning

confidence: 99%

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

et al. 2017

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Medical treatment for fistulizing Crohn's disease (FCD) is changing rapidly over the time by the introduction of novel therapeutic medicines, while no global consensus is available. This study aims to accomplish a systematic review and meta-analysis on the efficacy of tumor necrosis factor-alpha antibodies (anti-TNF-α antibodies) versus placebo in FCD. A systematic review of published literature was carried out till December 2016, and a meta-analysis of identified studies was done. Data have been explored from PubMed, Scopus, Cochrane Library Database, and Web of Science. Predefined exclusion criteria for included studies in meta-analysis are based on search methodology and are as follows: Randomized clinical trial about Crohn's disease (CD) patients without fistula, pediatrics CD, randomized clinical trials about pregnant women with FCD, nonhuman studies, randomized clinical trials with surgical therapies interventions, conference abstracts, case reports, and language other than English studies. All randomized placebo-controlled trials were included. To assess risk of bias, Jadad score was applied to evaluate trials' methodological quality. Relative risk (RR) and 95% confidence intervals were computed using Mantel-Haenszel and/or Rothman-Boice (for fixed effects) or Der Simonian-Laird (for random effects) techniques. Nine studies attained defined inclusion criteria. The meta-analysis results showed that anti-TNF-α antibodies are remarkably more effective in comparison to placebo for fistula closure maintenance (RR = 2.36; 95% confidence interval: 1.58–3.55; P < 0.0001) in patients with FCD, whereas anti-TNF-α antibodies were not superior to placebo neither in fistula improvement nor in fistula closure. We concluded that adalimumab and certolizumab pegol are both effective in fistula closure maintenance in adult patients with FCD.

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Surgical management of complicated rectovaginal fistulas and the role of omentoplasty

et al. 2017

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Emerging issues in the medical management of Crohnʼs disease

Abstract: The review will provide evidence to support decision making in patients with Crohn's disease requiring biologic and/or immunomodulator therapy.

Cited by 4 publications

References 38 publications

Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

Surgical management of complicated rectovaginal fistulas and the role of omentoplasty

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Emerging issues in the medical management of Crohnʼs disease

Abstract: The review will provide evidence to support decision making in patients with Crohn's disease requiring biologic and/or immunomodulator therapy.

Cited by 4 publications

References 38 publications

Optimal delivery of follow-up care after surgery for Crohn&rsquo;s disease: current perspectives

Optimal delivery of follow-up care after surgery for Crohn&rsquo;s disease: current perspectives

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

Surgical management of complicated rectovaginal fistulas and the role of omentoplasty

Contact Info

Product

Resources

About

Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives