Immunomodulators Are Associated With a Lower Risk of First Surgery Among Patients With Non-Penetrating Non-Stricturing Crohn's Disease

Picco, M.F.; Zubiaurre, Ignacio; Adluni, Mohamed; Cangemi, John R.; Shelton, Donna

doi:10.1038/ajg.2009.387

Cited by 58 publications

(27 citation statements)

References 24 publications

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“…In an attempt to avoid multiple operations, several trials of nonsurgical treatment for stenosis have been performed. Immunosuppressant [6] and biological [7,8] therapies might reduce the need for surgery but must be given early in disease progression, before the development of irreversible anatomical lesions [9]. Infliximab (IFX) treatment seems to be effective for preventing the development of new anastomotic lesions defined by endoscopic findings at 1 year [10].…”

Section: Introductionmentioning

confidence: 99%

Prediction of Maintained Mucosal Healing in Patients with Crohn's Disease under Treatment with Infliximab Using Diffusion-Weighted Magnetic Resonance Imaging

Sakuraba¹,

Ishiguro²,

Hasui³

et al. 2014

Digestion

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Background: Maintenance of mucosal healing may lead to a better outcome in patients with Crohn's disease (CD). Magnetic resonance diffusion-weighted imaging (MR-DWI) scans 1 year after infliximab (IFX) induction therapy were assessed as predictors of maintained response, or remission, through 3 years of treatment in patients with CD. Summary: MR-DWI and endoscopy data were prospectively collected throughout IFX treatment. Altogether, 86 lesions from 13 patients given IFX as induction (weeks 0, 2 and 6) and maintenance (5 mg/kg every 8 weeks beginning at week 14) therapy were analyzed with MR-DWI for 0.5-1.5 years from the starting point. Mucosal findings were confirmed by endoscopy at 1 and 3 years (gold standard). Of the 86 lesions, 65 were graded ‘0' and 21 were graded ‘1' based on their hyperintensity (HI; or lack thereof) on MR-DWI. Two years after the first evaluation, 7 of 15 false-negative lesions had turned positive based on colonoscopy findings, and 60 of 62 true-negative lesions had not. Thus, 0.03% of those predicted to remain in remission had relapsed (negative predictive value 0.9677, p < 0.0001). MR-DWI-HI at 1 year coincided with the presence of endoscopic inflammation, with sensitivity of 66.67%, specificity of 80.52%, and an area under the curve (AUC) value of 0.7359 (0.5479-0.9240, p = 0.0211). The AUC value of MR-DWI-HI at 3 years was 0.8402 (0.7460-0.9343, p = 0.001) with sensitivity of 94.12% and specificity of 73.91%. Key Message: A definition of the response on the basis of MR-DWI-HI might be helpful for optimizing treatment for patients with CD under treatment with IFX.

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Section: Introductionmentioning

confidence: 99%

Prediction of Maintained Mucosal Healing in Patients with Crohn's Disease under Treatment with Infliximab Using Diffusion-Weighted Magnetic Resonance Imaging

Sakuraba¹,

Ishiguro²,

Hasui³

et al. 2014

Digestion

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“…Indeed, AZA therapy was associated with a decreased risk of first surgery among patients with non-stricturing, non-penetrating CD [19]. In addition, after a first surgical resection for CD, long-term treatment with thiopurines appears to cut the risk of subsequent intestinal surgery by nearly 60% [20,21]. Nonetheless, to our knowledge this is the first study to demonstrate that AZA therapy can reduce surgical hospitalizations of sub-occlusive ileocecal CD patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of azathioprine or mesalazine therapy on incidence of re-hospitalization in sub-occlusive ileocecal Crohn’s disease patients

et al. 2013

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BackgroundAlthough the cost of Crohn’s disease (CD) treatment differs considerably, hospitalization and surgery costs account for most of the total treatment cost. Decreasing hospitalization and surgery rates are pivotal issues in reducing health-care costs.Material/MethodsWe evaluated the effect of azathioprine (AZA) compared with mesalazine on incidence of re-hospitalizations due to all causes and for CD-related surgeries. In this controlled, randomized study, 72 subjects with sub-occlusive ileocecal CD were randomized for AZA (2–3 mg/kg per day) or mesalazine (3.2 g per day) therapy during a 3-year period. The primary end point was the re-hospitalization proportion due to all causes, as well as for surgical procedures during this period evaluated between the groups.ResultsOn an intention-to-treat basis, the proportion of patients re-hospitalized within 36 months due to all causes was lower in patients treated with AZA compared to those on mesalazine (0.39 vs. 0.83, respectively; p=0.035). The AZA group had also significantly lower proportions of re-hospitalization for surgical intervention (0.25 vs. 0.56, respectively; p=0.011). The number of admissions (0.70 vs. 1.41, p=0.001) and the length of re-hospitalization (3.8 vs. 7.7 days; p=0.002) were both lower in AZA patients.ConclusionsPatients with sub-occlusive ileocecal CD treated with AZA had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. The long-term use of AZA in ileocecal CD patients recovering from a sub-occlusion episode can save healthcare costs.

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“…The anti-TNF- α Infliximab is at present the only proved drug to be able to modify the natural history of IBD [1, 3, 4, 9, 10]. …”

Section: Discussionmentioning

confidence: 99%

Colonic Perforation in a Child with Crohn's Disease: Successful Medical Treatment Rescues from Colectomy

Gasparetto

Giorgi

Kleon

et al. 2012

Case Reports in Gastrointestinal Medicine

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Background. The challenging treatment of penetrating paediatric Crohn's disease (CD) involves pharmacological and surgical approaches. Despite a proved efficacy of anti-TNF agents for treatment of complex fistula, a large number of patients cannot achieve a complete healing and relapse during the followup. Aim. We report a paediatric case with CD and colonic perforation who was successfully treated with medical therapy only, including anti-TNFα. Case Presentation. During a colonoscopy performed on a 9-year-old girl with CD, a perforation occurred in correspondence of a fistula at the colonic splenic flexure. The formation of a collection was then detected (US, enteric-CT), as well as a fistula connecting the colon to the collection. The girl was kept fasting and treated with total parenteral nutrition and antibiotic therapy. Treatment with Infliximab was also started, and after the third dose a US control showed disappearance of the collection and healing of the enteric fistula. Parenteral nutrition was progressively substituted with enteral feeding, and no surgical treatments were needed. Discussion. In pubertal children with penetrating CD, the option of an efficacious medical treatment to avoid a major surgical approach on the bowel is to be aimed for growth improvement. This approach requires a strictly monitored long-term followup.

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Immunomodulators Are Associated With a Lower Risk of First Surgery Among Patients With Non-Penetrating Non-Stricturing Crohn's Disease

Abstract: Immunomodulator use is associated with a decreased risk of first surgery among patients with non-stricturing non-penetrating CD. Early immunomodulator therapy may be beneficial in preventing first surgery in this population that has yet to develop penetrating or fistulizing complications.

Cited by 58 publications

References 24 publications

Prediction of Maintained Mucosal Healing in Patients with Crohn's Disease under Treatment with Infliximab Using Diffusion-Weighted Magnetic Resonance Imaging

Prediction of Maintained Mucosal Healing in Patients with Crohn's Disease under Treatment with Infliximab Using Diffusion-Weighted Magnetic Resonance Imaging

Effect of azathioprine or mesalazine therapy on incidence of re-hospitalization in sub-occlusive ileocecal Crohn’s disease patients

Colonic Perforation in a Child with Crohn's Disease: Successful Medical Treatment Rescues from Colectomy

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