C Ma et al. Inflamm Bowel Dis 2017; 23: 833-9. This retrospective study examined the ongoing response to ustekinumab in 104 patients with Crohn’s disease. All patients had achieved a steroid-free ustekinumab induction. 92.3% had failed anti-TNFα therapy.Key findings:
- 71.8% maintained a response at 52 weeks
- 64.4% maintained an endoscopic or radiographic response
Related blog post: Closer Look at Ustekinumab Data
O Truffinet et al JPGN 2017; 64: 721-25. This small study with 8 children with Crohn’s disease examined the use of tacrolimus. Six of eight showed a response to tacrolimus (target 8-15) with a clinical response at 2 months and 4 of 8 in clinical remission. Adverse effects were common, occurring in 6 of 8. These included renal dysfunction, diabetes, paresthesia and tremor.
J Adler et al. JPGN 2017; 64: e117-e124. Using ImproveCareNow registry, the authors identified perianal disease (PD) in 1399 of 6679 cases (21%). PD was more common in blacks than whites: 26% vs. 20%. Overall, this study showed a higher rate of PD than previously recognized.
J Amil-Dias et al JPGN 2017; 64: 818-35. This is an ESPGHAN IBD Porto Group guideline for surgical Crohn’s disease management in children. There are 25 graded statements. Here are a few:
- #7 & #8. If needing surgery for CD pancolitis, the authors recommend subtotal colectomy and ileostomy. Possible reanastomosis at later date if no significant rectal and/or perianal disease. Ileal pouch-anal anastomosis is NOT recommended.
- #13. Monitor Vitamin B12 if >20 cm resection of terminal ileum
- #16. Postoperative management “should be based on ileocolonoscopy.” Figure 1 details recommendations, including need for assessment postoperatively.
- In patients with high-risk factors, anti-TNF therapy is recommended postoperatively. In those without high-risk factors, the authors indicate that thiopurines are reasonable with and advancing to anti-TNF if Rutgeerts i2 or greater at followup assessment. High-risk factors include growth failure, short duration from diagnosis to surgery, extensive resection (>40 cm), and penetrating disease.
Related blog post:
- AGA 2017 Guidelines for Postoperative Crohn’s Disease
- Tacrolimus for Refractory Crohn’s Disease
- anal Fistulizing Disease | gutsandgrowth
- Pediatric Consensus Statement: Perianal Crohn Disease …
- Paris Classification of Pediatric Crohn’s Disease | gutsandgrowth