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. 2021 Jul;19(3):255-264.
doi: 10.5217/ir.2020.00029. Epub 2020 Nov 6.

Correlation of serum levels of anti-tumor necrosis factor agents with perianal fistula healing in Crohn's disease: a narrative review

Eron Fabio Miranda  1 , Rodrigo Bremer Nones  2 , Paulo Gustavo Kotze  1
Affiliations

Correlation of serum levels of anti-tumor necrosis factor agents with perianal fistula healing in Crohn's disease: a narrative review

Eron Fabio Miranda et al. Intest Res. 2021 Jul.

Abstract

With the overspread use of measurement of serum levels of anti-tumor necrosis factor (TNF) agents (therapeutic drug monitoring, TDM), new therapeutic strategies have been used in the management of Crohn's disease (CD). Different targets are correlated with increased levels of circulating drugs. Recent evidence demonstrated that higher serum levels of anti-TNF agents may be associated to better outcomes in perianal fistulizing CD (PFCD). Overall, patients with healed fistulas had higher serum levels of infliximab and adalimumab as compared to those with active drainage. This was demonstrated in some cohort studies, in induction and maintenance, in adults and children with PFCD. In this narrative review, authors summarize current evidence on the use of serum level measurement of anti-TNF agents and its correlation with perianal fistula healing in CD patients. Data on the use of TDM in PFCD is discussed in detail. The retrospective design of the studies and the lack of objective parameters to measure fistula healing are the main limitations of published data. Prospective studies, with central reading of objective radiological parameters, such as pelvic magnetic resonance imaging scores, can improve the level of evidence on the possible advantages of TDM in perianal fistula in CD and are warranted.

Keywords: Crohn disease; Fistula; Tumor necrosis factor-alpha.

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Conflict of interest statement

Conflict of Interest

Kotze PG is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

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