Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin, Lucie; Armengol-Debeir, Laura; Charpentier, C; Bridoux, Valérie; Köning, Edith; Savoye, Guillaume; Savoye‐Collet, Céline

doi:10.3748/wjg.v23.i23.4285

Cited by 30 publications

(28 citation statements)

References 47 publications

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“…A fistula was defined as “closed” in the absence of drainage, with gentle finger compression on examination. Nine papers defined “remission” as closure of all baseline fistulas; six studies required this over two consecutive evaluations and three at a single time point . Eight studies assessed for clinical “response.” This was defined as closure of ≥50% of baseline fistulas at a single time point in three papers, and across two consecutive visits in three papers .…”

Section: Resultsmentioning

confidence: 99%

“…Nine papers defined “remission” as closure of all baseline fistulas; six studies required this over two consecutive evaluations and three at a single time point . Eight studies assessed for clinical “response.” This was defined as closure of ≥50% of baseline fistulas at a single time point in three papers, and across two consecutive visits in three papers . In two papers, it was defined as either closure of ≥50% baseline draining fistulas or marked reduction in drainage of all fistulas with less pain and induration, as reported by the patient, across two consecutive visits …”

Section: Resultsmentioning

confidence: 99%

“…Of 60 patients, 4 (7%) had healing, 8 of 15 (53%) improvement, and 7 of 15 (47%) no response. Eight papers reported on radiological outcomes in the long term, at a median time of 72 weeks (IQR, 49–84 weeks), with a combined sample size of 148 patients. Of 148 papers, 37 (25%) had healing, 36 of 72 (50%) response, and 18 of 72 (25%) no response.…”

Section: Resultsmentioning

confidence: 99%

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Radiological outcomes in perianal fistulizing Crohn's disease: A systematic review and meta‐analysis

2019

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Perianal fistulas are a common and debilitating manifestation of Crohn's disease. Since the advent of biological agents, patient outcomes appear to have improved. While rates of clinical response and remission are well characterized in literature, magnetic resonance imaging (MRI) outcomes remain less so. This is despite previous studies demonstrating the persistence of fistula tracts on MRI, in spite of clinical healing, suggesting radiological markers of improvement may be more accurate. The aims of this study were to systematically review the literature for all studies reporting on MRI outcomes following biological therapy and to compare rates of radiological healing to clinical remission. A search was performed according to the Preferred Reporting Items For Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Nine articles were included, with a total sample size of 259 patients. Of these 259 patients, 47% achieved clinical remission following induction therapy and 42% following a median of 52 weeks' maintenance therapy. Out of the 259 patients, 7% achieved radiological healing in the short term and 25% in the long term. The odds ratio of MRI versus clinical healing was 0.10 (95% confidence interval [CI], 0.02–0.39) and 0.43 (95% CI, 0.26–0.71), respectively, at those corresponding time points. MRI healing of perianal fistulizing Crohn's, while arguably a more accurate assessment of treatment response, is significantly less common than clinical remission. Heterogeneity exists in the definition of radiological and clinical response, leading to variation in reported rates. Further studies, directly comparing the long‐term outcomes of patients achieving clinical remission and MRI healing are required, to better inform the role of MRI follow up in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Radiological outcomes in perianal fistulizing Crohn's disease: A systematic review and meta‐analysis

2019

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“…T2-weighted magnetic resonance imaging (MRI) with fat-suppression is considered the gold-standard for fistula imaging and an MRI-based score is currently available for defining disease activity, although it is still not widely used in clinical practice[ 1 ]. Thomassin et al[ 11 ] have recently showed that deep remission, defined as a composite clinical (absence of any draining fistulas and self-reported drainage episodes by the patient at two successive evaluations), endoscopic (absence of ulcers in the anal canal) and radiological (absence of T2 hyperintensity and contrast enhancement on MRI) remission, was achieved in approximately one-third of patients with perianal fistulizing CD[ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although several variables have been associated with improved outcomes (Table 2 ), prediction of deep remission remains a challenge. Thomassin et al[ 11 ] have recently identified absence of rectal involvement on MRI (OR = 4.6; 95%CI: 1.03-20.5) as the only variable associated with deep remission in patients with perianal fistulizing CD[ 11 ]. Similar to ulcerative colitis and luminal CD[ 19 - 25 ], recent data demonstrate that higher infliximab concentrations are associated with better clinical outcomes in patients with perianal fistulising CD[ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

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

Papamichael

Cheifetz

2017

WJG

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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.

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Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era

et al. 2020

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Background and AimWhile the advent of biologic therapy has led to improved outcomes in perianal fistulizing Crohn's disease (pfCD), loss of response is common. Previous studies suggest that patients who achieve radiological healing (with healing of underlying tracts on magnetic resonance imaging [MRI]) have a longer duration of response. The aim of this study was to characterize MRI outcomes of pfCD at a specialist inflammatory bowel disease (IBD) unit and compare the long‐term clinical outcomes between patients achieving MRI and clinical healing.MethodsA retrospective analysis of perianal fistulizing Crohn's patients treated at one specialist IBD unit was performed. Records were reviewed for patient demographics, disease history, clinical assessments, investigation results, and disease flares. Clinical remission was defined as closure of all baseline fistula openings. Radiological healing was defined as the absence of any T2‐hyperintense sinuses, tracts, or collections. The primary end‐point was rate of MRI healing. The secondary outcome was defined as flare‐free period (time between clinical or radiological healing and patients' first signs/symptoms requiring therapy escalation).ResultsA total of 93 patients were included, with a median follow‐up of 4.8 years (interquartile range, 2.4–6 years). Of 44 patients, 22 (50%) achieved clinical remission, while 15 of 93 (16%) achieved radiological healing. Of 22 patients, 10 (45%) with clinical remission had a subsequent disease flare (median time of 7 months) compared with 3 of 15 (20%) patients with MRI healing (median time of 3.6 years). Radiological healing was associated with a significantly longer flare‐free period (P = 0.01).ConclusionRadiological healing occurs less commonly but represents a deeper form of healing, associated with improved long‐term clinical outcomes.

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Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Cited by 30 publications

References 47 publications

Radiological outcomes in perianal fistulizing Crohn's disease: A systematic review and meta‐analysis

Radiological outcomes in perianal fistulizing Crohn's disease: A systematic review and meta‐analysis

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

Long‐term outcomes of perianal fistulizing Crohn's disease in the biologic era

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