Patil SA et al. – Initiation of anti–TNF therapy for treatment of Crohn's disease (CD) is associated with a significant reduction in diagnostic radiation exposure. Conversely, steroid treatment does not reduce diagnostic radiation exposure.Methods
- The authors conducted a retrospective review of 99 CD patients initiated on anti-TNF therapy or corticosteroids between 2004 and 2009 in a tertiary care center.
- Sixty-five patients were initiated on anti-TNF agents and 34 were initiated on corticosteroids.
- The anti-TNF cohort was significantly younger at diagnosis and at the time of initiation of anti-TNF or steroid therapy.
- The anti-TNF group had significantly more stricturing, penetrating, and perianal disease than the corticosteroid group.
- The anti-TNF cohort had a significant reduction in number of radiologic exams (5.5 vs. 3.7, P<0.01) as well as a significant reduction in the cumulative radiation dose (28.1 vs. 15.0 mSv, P<0.01) the year after initiation of therapy.
- This reduction was largely attributable to decreased use of computed tomography (CT) scans.
- In contrast, there was no significant change in radiation exposure in the corticosteroid cohort.
- Logistic regression analysis showed a strong trend toward higher exposure in patients with complicated disease behavior (stricturing or penetrating phenotype) (odds ratio [OR] 2.87, 95% confidence interval [CI] 0.98-8.38).