TY - JOUR
T1 - Development of an MRI-Based Prediction Model for Anti-TNF Treatment Failure in Perianal Crohn's Disease
T2 - A Multicenter Study
AU - the Canadian IBD Research Consortium
AU - McCurdy, Jeffrey D.
AU - Munir, Javeria
AU - Parlow, Simon
AU - Reid, Jacqueline
AU - Yanofsky, Russell
AU - Alenezi, Talal
AU - Meserve, Joseph
AU - Becker, Brenda
AU - Lahijanian, Zubin
AU - Eddin, Anas Hussam
AU - Mallick, Ranjeeta
AU - Ramsay, Tim
AU - Rosenfeld, Greg
AU - Bessissow, Ali
AU - Bessissow, Talat
AU - Jairath, Vipul
AU - Singh, Siddharth
AU - Bruining, David H.
AU - Macdonald, Blair
N1 - Publisher Copyright:
© 2024 AGA Institute
PY - 2024/5
Y1 - 2024/5
N2 - 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.
AB - 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.
KW - IBD Complications
KW - Perianal Crohn's Disease
KW - Predictive Model
UR - http://www.scopus.com/inward/record.url?scp=85184074723&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85184074723&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2023.12.006
DO - 10.1016/j.cgh.2023.12.006
M3 - Article
C2 - 38122958
AN - SCOPUS:85184074723
SN - 1542-3565
VL - 22
SP - 1058-1066.e2
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 5
ER -