Higher anti-tumor necrosis factor levels are associated with perianal fistula healing and fistula closure in Crohn's disease.

Abstract

OBJECTIVE:

Limited data are available regarding the relationship between anti-tumor necrosis factor (TNF) drug/antibody levels and perianal fistula outcomes in Crohn's disease. The aims of this study were to assess the relationship between maintenance anti-TNF levels and perianal fistula outcomes.

METHODS:

This was a retrospective cross-sectional study of patients receiving maintenance adalimumab or infliximab therapy (minimum 24 weeks) for the treatment of Crohn's disease with associated perianal fistulas, who had anti-TNF drug/antibody levels (trough for infliximab) measured within 4 weeks of clinical assessment. The primary outcome was the association of anti-TNF levels with perianal fistula healing defined as the absence of drainage. The secondary outcome was the association of anti-TNF levels with complete perianal fistula closure.

RESULTS:

A total of 64 patients (adalimumab, n = 35; infliximab, n = 29) were included. Patients with fistula healing had higher levels of anti-TNF vs. those without fistula healing (adalimumab: 12.6 vs. 2.7 μg/mL, P < 0.01; infliximab: 8.1 vs. 3.2 μg/mL, P < 0.01). Patients with fistula closure also had significantly higher anti-TNF levels vs. those without fistula closure (adalimumab: 14.8 vs. 5.7 μg/mL, P < 0.01; infliximab: 8.2 vs. 3.2 μg/mL, P < 0.01). For adalimumab, receiver operator characteristic analysis identified an optimum level of >6.8 μg/mL and >9.8 μg/mL for fistula healing and closure, respectively. For infliximab, receiver operator characteristic analysis identified an optimum trough level of >7.1 μg/mL for both fistula healing and closure.

CONCLUSION:

Higher maintenance anti-TNF levels are associated with perianal fistula healing and closure in Crohn's disease.

• Authors: Nikolas Plevris, Philip W Jenkinson, Ian D Arnott, Gareth R Jones, Charlie W Lees
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 32 Issue 1 Pg. 32-37 (01 2020) ISSN: 1473-5687 [Electronic] England
• PMID: 31567638 (Publication Type: Journal Article)

Chemical References

• Tumor Necrosis Factor Inhibitors
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab

Topics

• Adalimumab (therapeutic use)
• Crohn Disease (diagnosis, drug therapy)
• Cross-Sectional Studies
• Humans
• Infliximab (adverse effects)
• Rectal Fistula (drug therapy, etiology, surgery)
• Retrospective Studies
• Treatment Outcome
• Tumor Necrosis Factor Inhibitors
• Tumor Necrosis Factor-alpha