Anti-TNF therapy is associated with decreased imaging and radiation exposure in patients with Crohns disease
Inflammatory Bowel Disease,  Clinical Article

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.

Results
  • 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).

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