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Development of an MRI-Based Prediction Model for Anti-TNF Treatment Failure in Perianal Crohn's Disease: A
Jeffrey D McCurdy1, Javeria Munir2, Simon Parlow3
1Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
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.
Insights
This study developed prediction models using clinical and MRI data to identify patients with Crohn's disease-related perianal fistulas (PAF) likely to experience anti-tumor necrosis factor (TNF) treatment failure. These models accurately predict treatment outcomes.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Perianal fistula (PAF) outcomes in Crohn's disease are not well understood.
- Predicting anti-tumor necrosis factor (TNF) treatment failure in PAF is crucial for patient management.
Purpose of the Study:
- To develop and validate prediction models for anti-TNF treatment failure in patients with Crohn's disease-related PAF.
- To assess the predictive performance of these models against existing imaging scores.
Main Methods:
- A multicenter retrospective study of 221 biologic-naive adults with PAF treated with anti-TNF therapy.
- Development of a prediction model using clinical data and detailed pelvic MRI parameters.
- Internal validation and comparison with MAGNIFI-CD and modified Van Assche MRI scores.
Main Results:
- Treatment failure occurred in 46% of patients.
- The prediction model incorporated age, time to treatment, smoking status, and 8 MRI characteristics.
- The developed models demonstrated fair discriminatory capacity and outperformed existing imaging indices.
Conclusions:
- Clinical and radiologic variables can be used to develop accurate risk prediction models for anti-TNF treatment failure in PAF.
- These models offer improved prediction compared to current imaging-based scores.
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