Long-term MRI-guided combined anti-TNF-α and thiopurine therapy for crohn's perianal fistulas
Inflammatory Bowel Disease,  Clinical Article

Tozer P et al. – Combination anti–tumor necrosis factor (TNF) and thiopurine therapy provides sustained benefit in patients with perianal Crohn's disease (CD) fistula. Early clinical response is associated with subsequent clinical remission. Radiological healing is slower than clinical healing. Radiologically healed fistula tracts maintain healing on infliximab but can recur after cessation of therapy.

Methods
  • Consecutive patients with CD-related perianal (anal, rectovaginal, anolabial) fistulas treated with infliximab or adalimumab were monitored prospectively both clinically and radiologically using magnetic resonance imaging (MRI).

Results
  • Forty-one consecutive patients with CD-related perianal fistulas were treated with infliximab (n=32) or adalimumab (n=9; following infliximab failure) in combination with a thiopurine (unless intolerant).
  • Fifty-eight percent of all patients, comprising 66% and 43% of infliximab and adalimumab-treated patients, respectively, demonstrated remission or response at 3 years.
  • Thirty-three percent of infliximab treated patients maintained clinical remission at 3 years.
  • Radiological healing lagged behind clinical remission by a median of 12 months.
  • The likelihood of clinical remission at any time was five times greater in patients who had early clinical response within 6 weeks than those without.
  • A higher number of fistula tracts was associated with reduced clinical remission.
  • All patients who achieved radiological healing maintained healing on infliximab treatment, while only 43% maintained healing after cessation of anti-TNF therapy.

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Nursing

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Nursing Articles

1 Yogurt consumption, weight change and risk of overweight/obesity: The SUN cohort study Nutrition, Metabolism & Cardiovascular Diseases, July 28, 2014    Clinical Article

2 Vitamin D and sleep disorders Full Text Nature and Science of Sleep, August 13, 2014    Free full text    Clinical Article

3 Blood pressure in relation to coffee and caffeine consumption Current Hypertension Reports, August 8, 2014    Review Article

4 Metformin in chronic kidney disease: Time for a rethink Peritoneal Dialysis International, July 9, 2014    Clinical Article

5 Suffering from constipation? Self-acupressure can help UCLA Health System, November 19, 2014

6 Effect of ginger (Zingiber officinale) on heavy menstrual bleeding: a placebo-controlled, randomized clinical trial Phytotherapy Research, October 13, 2014    Clinical Article

7 UAB plans clinical trial for repurposed drug shown to reverse diabetes UAB Medicine, November 12, 2014

8 Long-term associations of nut consumption with body weight and obesity American Journal of Clinical Nutrition, June 23, 2014    Clinical Article

9 Decreased ability to identify odors can predict death The University of Chicago Medical Center News, October 3, 2014

10 Chocolate intake and diabetes risk Clinical Nutrition, July 21, 2014    Clinical Article

11 Vitamin D and the risk of dementia and Alzheimer's disease Neurology®, August 27, 2014    Clinical Article

12 Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: A comprehensive review and meta-analysis European Journal of Cancer, August 7, 2014    Review Article

13 Study identifies best way to treat neck pain Johns Hopkins Medicine, October 24, 2014

14 Yogurt and weight management American Journal of Clinical Nutrition, April 3, 2014    Review Article

15 Proton pump inhibitors decrease diversity in gut microbiome, increase risk for complications Mayo Clinic, November 25, 2014

16 'Tis the season to indulge in walnuts UC Davis Health System, November 17, 2014

17 Fish consumption and risk of gastrointestinal cancers: A meta-analysis of cohort studies Full Text World Journal of Gastroenterology, November 17, 2014    Free full text    Evidence Based Medicine

18 Associations of sugar and artificially sweetened soda and chronic kidney disease: A systematic review and meta-analysis Nephrology, September 24, 2014    Evidence Based Medicine    Review Article

19 Eating habits, body fat related to differences in brain chemistry Full Text NIH News, September 10, 2014    Free full text

20 Dairy product consumption and gastric cancer risk: A meta-analysis Full Text World Journal of Gastroenterology, November 14, 2014    Free full text    Evidence Based Medicine

Indexed Journals in Nursing: Journal of Advanced Nursing, Journal of Clinical Nursing, Nurse Education In Practicemore