Early anti-TNF induction may link to long-term fistula healing in Crohns disease
Click Here to Manage Email Alerts
Early infliximab therapy initiation following surgery may result in long-term fistula healing among patients with perianal fistulizing Crohn’s disease, according to research published in BMC Gastroenterology.
“Antitumor necrosis factor agents are effective in the induction and maintenance of fistula closure and are currently recommended as the first-line medical therapy for perianal fistulizing CD (PFCD). Further data suggested that combining surgery with infliximab could improve fistula closure and prevent fistula recurrence, compared with single treatment alone,” Ping Zhu, of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, and colleagues wrote. “There is currently no guideline or consensus statement regarding the timing between surgical intervention and commencement of medical therapy.”
In a retrospective cohort study, researchers aimed to determine the long-term efficacy of infliximab initiation following surgery among 117 patients with PFCD grouped according to the time interval between surgery and infusion (< 6 weeks, early infliximab induction: n = 73; > 6 weeks, delayed infliximab induction: n = 44). They compared surgical reintervention between groups, evaluated fistula healing and investigated predictors associated with these outcomes during early infliximab induction.
According to study results, 61.6% of patients in the early induction group and 65.9% of patients in the delayed induction group achieved total fistula healing. The reintervention rate at 1 year, 2 years and 3 years was 23%, 32% and 34% in the early induction group and 16%, 25% and 25% in the late induction group, respectively. At the end of follow-up, 63.2% of patients maintained fistula healing; of those, 48.7% maintained fistula healing without reintervention following their initial surgery. Researchers noted no difference between groups for total fistula healing or reintervention-free fistula healing (45.2% vs. 54.6%).
On multivariate analysis, reintervention associated with the presence of abscess at baseline (HR = 5.283; 95% CI, 1.61-17.335; P = .006) and infliximab maintenance therapy of greater than three infusions (HR = 3.691; 95% CI, 1.23-11.051; P = .02) in the early induction group. Abscess at baseline also correlated with a negative influence on fistula healing (HR = 3.429; 95% CI, 1.216-9.669; P = .02).
“Early initiation of infliximab therapy after surgery could result in long-term fistula healing in a significant proportion of PFCD patients with an acceptable surgical reintervention rate. For patients with concomitant perianal abscess or requiring prolonged infliximab maintenance therapy, a longer time interval is warranted to establish durable drainage before infliximab therapy is initiated,” Zhu and colleagues concluded. “The optimal timing to initiate medical treatment needs to be determined in future studies.”
Collapse
Read more about
Click Here to Manage Email Alerts