Combined Therapy With Surgery and Anti-TNF Therapy for Perianal Crohnʼs Disease: Seton Withdrawal Timing Data From a Brazilian Case Series
Notice bibliographique
Résumé
Perianal fistulizing Crohn's disease (CD) is one of the most severe phenotypes of inflammatory bowel diseases (IBD). Combined therapy with examination under anesthesia, seton placement and anti-TNF therapy is the most common strategy for the management of this condition. There is still lack of data regarding the proper timing of seton withdrawal after induction therapy with anti-TNF agents, and the criteria for its determination is undefined. The aim of this study was to analyze the timing of seton withdrawal in a Brazilian case series of perianal fistulizing CD patients. This was a retrospective observational study that included Brazilian patients with perianal fistulizing CD submitted to combined therapy with examination under anesthesia and seton placement followed by anti-TNF therapy, from 4 IBD referral centres, from January 2009 to June 2012. Electronic chart review was performed and data were inputted in a specific protocol. We analyzed patients' demographic characteristics, Montreal classification, concomitant medication, type of biological agent, classification of the fistulae, occurrence of perianal complete remission, number of setons placed and timing of seton withdrawal. Complete perianal remission was defined as absence of drainage from the fistula tracks without after seton removal. A total of 78 patients were included, 44 females (55.8%) with a mean age of 33.8 (±15) years. Medium time of CD diagnosis was 88.9 (±76.8) months. Montreal Classification: age at diagnosis (A1 = 21.8%, A2 = 50% e A3 = 28.2%); disease location (L1 = 0%, L2 = 7.7%, L3 = 78.2% e L4 = 14.1%); disease phenotype (B3 in 100% of the cases). Azathioprine was used in combination with the anti-TNF agents in 76.6% of the cases, 66.2% of the patients were treated with Infliximab (IFX) and 33.8% with Adalimumab (ADA). Complex fistulae were found in 52/78 patients (66.7%). Medium follow-up period was 48.2 months, and 52,6% of the patients had complete perianal remission. The average number of setons placed was 2 (±1.4) per patient, ranging from 1 to 7. Seton withdrawal occurred in 51 patients (±5.3%), performed in an average period of 7.3 (±6,4; 1 to 36) months. After combined surgery with seton placement and anti-TNF therapy, approximately 2/3 of the patients had their setons removed in this study, and the average period for the withdrawal was 7.3 months. There is still unclear criteria for the definition of the proper timing for seton withdrawal with the aim of perianal complete remission, and an individualized approach is recommended.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».