Defining and predicting deep remission in patients with perianal fistulizing Crohn’s disease on anti-tumor necrosis factor therapy

Abstract

Perianal fistulas can occur to up to one-third of patients with Crohn’s disease (CD) leading to significant disabling disease and morbidity. Fistulising perianal CD treatment often necessitates a combined pharmacological and surgical approach. Anti-tumor necrosis factor (anti-TNF) therapy, particularly infliximab, has been shown to be very effective for both perianal and internal fistulising CD. Nevertheless, current data suggest that sustained remission and long-term complete fistula healing can be achieved in only 30% to 50% of patients. Moreover, these percentages refer mostly to clinical rather than deep remission, defined as endoscopic and radiologic remission, which is quickly emerging as the preferred goal of therapy. Unfortunately, the therapeutic options for perianal fistulising CD are still limited. As such, it would be of great value to be able to predict, and more importantly, prevent treatment failure in these patients by early and continued optimization of anti-TNF therapy. Similar to ulcerative colitis and luminal CD, recent data demonstrate that higher infliximab concentrations are associated with better clinical outcomes in patients with perianal fistulising CD. This suggests that therapeutic drug monitoring and a treat-to-trough therapeutic approach may emerge as the new standard of care for optimizing anti-TNF therapy in patients with perianal fistulising CD.

Barbaloin Attenuates Mucosal Damage in Experimental Models of Rat Colitis by Regulating Inflammation and the AMPK Signaling Pathway

“…In the present study, significant differences in body weight, colonic W/L ratio, and histologic score were found among DSS-treated and control group rats, and barbaloin treatment could successfully reverse these disease activity indices, implying that it may be applicable in UC treatment in humans. Various attempts have been made to recover normal immune response by administering pure natural compounds, confirmed to play protective roles in various inflammatory diseases [18]. Barbaloin is the major anthraquinone obtained from aloe leaf exudates [19,20], and previous studies noted that it plays an important role in immune regulation, intestinal moistening, and defecation [20][21][22].…”

Surgery in the age of biologics

“…Subsequent studies also demonstrated the benefit of adalimunab but, again, complete healing rates were low, at only approximately one in three patients [96]. A recent review of outcomes in biologic therapy summarizes some of the reporting inconsistencies in studies to date [97]. While some studies demonstrate a benefit in the majority of patients, complete healing or clinical absence of symptoms occurs in only approximately 30%–40% of patients with biologic treatment.…”

Predictive value of blood concentration of biologics on endoscopic inactivity in inflammatory bowel disease: A systematic review

“…In fact, by considering the segmental and transmural inflammation of the intestine in CD, diagnostic imaging tests have been put forwarded for detecting deep lesions whereas histological detection is not recommended due to tiny and shallow biopsies, especially in pfCD. Currently, gastroenterologists have opted deep remission as fistula healing or fistula closure under endoscopic examination or other radiological examinations to be the primary endpoint of pfCD[ 58 ]. T2-weighted MRI with fat-suppression is considered the gold-standard for fistula imaging and an MRI-based score is currently available for defining disease activity[ 59 ].…”