Adalimumab or infliximab: which is better for perianal fistula in Crohn's disease?

Im, Jong Pil

doi:10.5217/ir.2017.15.2.147

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…One study reported that the incidence of pCD in Asia ranges from 30.3% to 58.8%, 20 but our results revealed that the incidence of pCD was 14.8%. Several reasons may exist for this lower prevalence of pCD in our study.…”

Section: Discussioncontrasting

confidence: 85%

Epidemiology, Disease Course, and Clinical Outcomes of Perianal Fistulas and Fissures Crohn’s Disease: A Nationwide Population-Based Study in Taiwan

Lin

Huang

Karki

et al. 2023

Crohn's &Amp; Colitis 360

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Background Population-based data on the course of perianal disease in East Asian populations with Crohn’s disease (CD) are limited. This study examined the prevalence, clinical course, and compared the outcomes of CD patients with perianal CD (pCD) versus without pCD in Taiwan. Methods A nationwide population-based study was implemented from 2000 to 2017 by using the Taiwan National Health Insurance Research Database. Results Of 2424 patients with CD, 358 (14.8%) patients with pCD were identified. Most patients with CD and pCD were men (79.3%). The mean age at CD diagnosis was lower in patients with pCD (33.7 years) than in those without pCD (44.9 years). Approximately half the patients with pCD received the pCD diagnosis at least 6 months before receiving a CD diagnosis. Approximately one third (121/358) of patients with pCD had recurrent fistula; the median recurrence interval was 239 days. Compared with patients without pCD, patients with pCD had higher mean incidences of hospitalization (7.0 vs 3.8, P < 0.01), outpatient visits (13 vs 2.9, P < 0.01), and emergency room visits (10.3 vs 4.4, P < 0.01) over a 15-year period. Although patients with pCD had higher rates of health-care utilization, their 15-year mortality rate was lower than that for those without pCD (6.1% vs 17.3%, P < 0.01). Conclusions The period prevalence of pCD in Taiwanese patients with CD was 14.8%. Although patients with pCD required more intensive care and had greater health-care utilization, they did not have inferior survival outcomes compared with those without pCD.

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Section: Discussioncontrasting

confidence: 85%

Epidemiology, Disease Course, and Clinical Outcomes of Perianal Fistulas and Fissures Crohn’s Disease: A Nationwide Population-Based Study in Taiwan

Lin

Huang

Karki

et al. 2023

Crohn's &Amp; Colitis 360

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“…Perianal fistula is one of the most common complications in Crohn’s disease (CD), with an estimated lifetime risk in western patients of 14% to 38% [ 4 ]. The incidence of perianal complications is higher in East Asian than in western patients, ranging from 30.3% to 58.8% [ 5 ]. Moreover, the incidence of CD is increasing in Asia, with 43% of CD patients in South Korea having perianal fistula [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative perianal fistula closure rates following autologous adipose tissue-derived stem cell transplantation or treatment with anti-tumor necrosis factor agents after seton placement in patients with Crohn’s disease: a retrospective observational study

et al. 2021

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Background Perianal fistula is one of the most common complications in Crohn’s disease, and various medical and surgical treatments are being tried. The aim of this study was to compare the perianal fistula closure rates following treatment with anti-tumor necrosis factor (TNF) agents or autologous adipose tissue-derived stem cell (auto-ASC) transplantation with Crohn’s disease (CD). Methods CD patients who underwent seton placement for perianal fistula from January 2015 to December 2019 at a tertiary referral center were retrospectively reviewed. Patients were divided into two groups, one that received sequential treatments with anti-TNF agents (anti-TNF group) and the other that underwent auto-ASC transplantation (stem cell group). Clinical variables and fistula closure rates were compared in the two groups. Results Of the 69 patients analyzed, 39 were treated with anti-TNF agents and 30 underwent auto-ASC transplantation. Compared with the stem cell group, patients in the anti-TNF group were older (p=0.028), were more frequently male (p=0.019), had fistulas with more penetrating behavior (p=0.002), had undergone surgery more frequently (p=0.010), and had a shorter interval from seton placement to intended treatment (p<0.001). During a median follow-up of 46 months (range, 30–52.5 months), fistula closure rates were significantly faster (83.3% vs. 23.1%, p<0.001), and the mean interval from seton placement to fistula closure significantly shorter (14 vs. 37 months, p<0.001) in the stem cell than in the anti-TNF group. Three patients experienced fistula recurrence, all in the stem cell group. Conclusions Medical treatment using anti-TNF agents and auto-ASC transplantation are feasible treatment options after seton placement for Crohn’s perianal fistula. However, the closure rate was significantly faster and the time to closure significantly shorter in patients who underwent auto-ASC transplantation than medical treatment. Trial registration This study was retrospectively registered and approved by the Institutional Review Board of Asan Medical Center, number 2020-1059.

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“… 17 Compared to Western countries, the prevalence of perianal complication is likely to be higher in East Asia, ranging from 30.3% to 58.8%. 17 Perianal lesions present with a spectrum of clinical severity from asymptomatic to severe diseases requiring repeated surgical interventions with medical treatment including antibiotics and tumor necrosis factor (TNF)-α antagonists in patients with CD. 18 In addition, perianal complications generally denote an aggressive and disabling phenotype of CD.…”

Section: Introductionmentioning

confidence: 99%

Association of Perianal Fistulas with Clinical Features and Prognosis of Crohn's Disease in Korea: Results from the CONNECT Study

Chun

Kim

et al. 2018

Gut and Liver

Self Cite

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Background/AimsThe disease course and factors associated with poor prognosis in Korean patients with Crohn’s disease (CD) have not been fully determined. The aim of this study was to explore potential associations between the clinical characteristics and long-term outcomes of CD and perianal fistulas in a Korean population.MethodsThe retrospective Crohn’s Disease Clinical Network and Cohort (CONNECT) study enrolled patients diagnosed with CD between July 1982 and December 2008 from 32 hospitals. Those followed for <12 months were excluded. Clinical outcomes were CD-related surgery and complications, including nonperianal fistulas, strictures, and intra-abdominal abscesses.ResultsThe mean follow-up period was 8.77 years (range, 1.0 to 25.8 years). A total of 1,193 CD patients were enrolled, of whom 465 (39.0%) experienced perianal fistulas. Perianal fistulizing CD was significantly associated with younger age, male gender, CD diagnosed at primary care clinics, and ileocolonic involvement. Both nonperianal fistulas (p=0.034) and intra-abdominal abscesses (p=0.020) were significantly more common in CD patients with perianal fistulas than in those without perianal fistulas. The rates of complicated strictures and CD-related surgery were similar between the groups. Independently associated factors of nonperianal fistulas were perianal fistulas (p=0.015), female gender (p=0.048), CD diagnosed at referral hospital (p=0.003), and upper gastrointestinal (UGI) involvement (p=0.001). Furthermore, perianal fistulas (p=0.048) and UGI involvement (p=0.012) were independently associated with the risk of intra-abdominal abscesses.ConclusionsPerianal fistulas predicted the development of nonperianal fistulas and intra-abdominal abscesses in Korean CD patients. Therefore, patients with perianal fistulizing CD should be carefully monitored for complicated fistulas or abscesses.

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Adalimumab or infliximab: which is better for perianal fistula in Crohn's disease?

Cited by 6 publications

References 10 publications

Epidemiology, Disease Course, and Clinical Outcomes of Perianal Fistulas and Fissures Crohn’s Disease: A Nationwide Population-Based Study in Taiwan

Epidemiology, Disease Course, and Clinical Outcomes of Perianal Fistulas and Fissures Crohn’s Disease: A Nationwide Population-Based Study in Taiwan

Comparative perianal fistula closure rates following autologous adipose tissue-derived stem cell transplantation or treatment with anti-tumor necrosis factor agents after seton placement in patients with Crohn’s disease: a retrospective observational study

Association of Perianal Fistulas with Clinical Features and Prognosis of Crohn's Disease in Korea: Results from the CONNECT Study

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