Division of Gastroenterology and Hepatology, The Ottawa Hospital, 737 Parkdale Ave, Suite 468, Ottawa, ON, K1Y 1J8, Canada.
The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
Dig Dis Sci. 2020 Jun;65(6):1784-1789. doi: 10.1007/s10620-019-05905-y. Epub 2019 Oct 22.
Complex perianal fistulas occurring in the absence of luminal inflammation (isolated perianal disease, IPD) may represent a specific phenotype of Crohn's disease (CD).
We assessed the effectiveness of tumor necrosis factor (TNF)-antagonists in patients with IPD compared to those with perianal CD (PCD) with luminal inflammation.
Patients were identified through our institutional radiology database and were classified as PCD or IPD based on the presence or absence of luminal inflammation by ileocolonoscopy and abdominal enterography. Consecutive adults (> 17 years) with recurrent IPD who were treated with TNF antagonists were matched by age and gender to patients with complex PCD (1:2 ratio). Fistula remission was defined as an absence of fistula drainage. Surgery-free survival was assessed by Cox proportional hazard models.
Twenty-two patients with IPD treated with a TNF antagonist were compared with 44 matched patients with PCD. A similar proportion of patients with IPD and PCD were treated with concomitant immunomodulators (55% vs. 66%) and underwent examinations under anesthesia prior to therapy (36% vs. 46%). Fistula remission at 3, 6, and 12 months was lower for the IPD cohort: 9.5% versus 34%; 19% versus 39%; and 19% versus 43%. Surgical intervention after initiating anti-TNF therapy was more common for patients with IPD (HR 3.99: 95% CI, 1.62-9.83; p = 0.0026).
Fewer patients with IPD achieved fistula remission, and more required surgical intervention after anti-TNF therapy, suggesting that TNF antagonists may not be as effective in these patients.
发生于无腔道炎症（孤立性肛周疾病，IPD）的复杂肛周瘘可能代表克罗恩病（CD）的一种特定表型。
我们评估了肿瘤坏死因子（TNF）拮抗剂在 IPD 患者中的疗效，与存在腔道炎症的肛周 CD（PCD）患者相比。
我们通过机构放射学数据库识别患者，并根据经结肠镜和腹部肠造影检查有无腔道炎症将患者分为 PCD 或 IPD。对接受 TNF 拮抗剂治疗的复发性 IPD 连续成年（>17 岁）患者，按照年龄和性别与复杂 PCD 患者（1:2 比例）进行匹配。瘘管缓解定义为无瘘管引流。采用 Cox 比例风险模型评估无手术生存情况。
将 22 例接受 TNF 拮抗剂治疗的 IPD 患者与 44 例匹配的 PCD 患者进行比较。接受免疫调节剂治疗的 IPD 和 PCD 患者比例相似（55%比 66%），并且在治疗前都进行了麻醉下检查（36%比 46%）。在第 3、6 和 12 个月时，IPD 患者的瘘管缓解率较低：9.5%比 34%；19%比 39%；19%比 43%。在开始抗 TNF 治疗后，IPD 患者更常见接受手术干预（HR 3.99：95%CI，1.62-9.83；p=0.0026）。
较少的 IPD 患者实现瘘管缓解，并且更多患者在接受抗 TNF 治疗后需要手术干预，这表明 TNF 拮抗剂在这些患者中可能效果不佳。
