Development of an MRI-Based Prediction Model for Anti-TNF Treatment Failure in Perianal Crohn's Disease: A Multicenter Study Clin Gastroenterol Hepatol. 2024 May;22(5):1058-1066.e2.doi:10.1016/j.cgh.2023.12.006. Epub 2023 Dec 18.
Jeffrey D McCurdy 1, Javeria Munir 2, Simon Parlow 3, Jacqueline Reid 4, Russell Yanofsky 5, Talal Alenezi 5, Joseph Meserve 6, Brenda Becker 7, Zubin Lahijanian 8, Anas Hussam Eddin 9, Ranjeeta Mallick 10, Tim Ramsay 10, Greg Rosenfeld 4, Ali Bessissow 8, Talat Bessissow 5, Vipul Jairath 9, Siddharth Singh 6, David H Bruining 7, Blair Macdonald 11; Canadian IBD Research Consortium |
Author information 1Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: jmccurdy@toh.on.ca. 2Division of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada. 3Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 4Department of Medicine, UBC, Vancouver, British Columbia, Canada. 5Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada. 6Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California. 7Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 8Division of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada. 9Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada. 10Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. 11Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada. Abstract Background & aims: Clinical and radiologic variables associated with perianal fistula (PAF) outcomes are poorly understood. We developed prediction models for anti-tumor necrosis factor (TNF) treatment failure in patients with Crohn's disease-related PAF. Methods: In a multicenter retrospective study between 2005 and 2022 we included biologic-naive adults (>17 years) who initiated their first anti-TNF therapy for PAF after pelvic magnetic resonance imaging (MRI). Pretreatment MRI studies were prospectively reread centrally by blinded radiologists. We developed and internally validated a prediction model based on clinical and radiologic parameters to predict the likelihood of anti-TNF treatment failure, clinically, at 6 months. We compared our model and a simplified version of MRI parameters alone with existing imaging-based PAF activity indices (MAGNIFI-CD and modified Van Assche MRI scores) by De Long statistical test. Results: We included 221 patients: 32 ± 14 years, 60% males, 76% complex fistulas; 68% treated with infliximab and 32% treated with adalimumab. Treatment failure occurred in 102 (46%) patients. Our prediction model included age at PAF diagnosis, time to initiate anti-TNF treatment, and smoking and 8 MRI characteristics (supra/extrasphincteric anatomy, fistula length >4.3 cm, primary tracts >1, secondary tracts >1, external openings >1, tract hyperintensity on T1-weighted imaging, horseshoe anatomy, and collections >1.3 cm). Our full and simplified MRI models had fair discriminatory capacity for anti-TNF treatment failure (concordance statistic, 0.67 and 0.65, respectively) and outperformed MAGNIFI-CD (P = .002 and < .0005) and modified Van Assche MRI scores (P < .0001 and < .0001), respectively. Conclusions: Our risk prediction models consisting of clinical and/or radiologic variables accurately predict treatment failure in patients with PAF. |
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