Evaluating the effectiveness of infliximab on perianal fistulizing Crohn's disease by magnetic resonance imaging

Background and aim: Data on the radiologic evaluation of perianal fistulizing Crohn's disease (PFCD) naive to anti-tumor necrosis factor therapy are scarce, especially in Asian populations. We assessed the effectiveness of infliximab (IFX) on PFCD and explored predictors of 'deep remission' based on clinical and radiologic assessments. Methods: Patients with Crohn's disease and active anal fistulas attending our care center for IFX therapy were prospectively enrolled. Each patient underwent clinical examination according to the Fistula Drainage Assessment Index, endoscopy for assessment of Crohn's Disease Activity Index (CDAI) and Perianal Crohn's Disease Activity Index (PCDAI), magnetic resonance imaging (MRI) to determine Van Assche score and Ng score, and laboratory tests up to 2weeks prior to the start of and up to 2weeks after the sixth IFX therapy (Week 32). Results: Among 38 patients treated with IFX, 52.6% achieved clinical remission based on the Fistula Drainage Assessment Index and 42.1% achieved deep remission based on Ng score. Van Assche score (from 14.5 +/- 4.26 to 7.36 +/- 7.53), CDAI (from 170 +/- 92 to 71 +/- 69) and PCDAI (from 7.45 +/- 2.65 to 2.44 +/- 3.20) decreased significantly after six IFX treatments. The only predictor of deep remission was simple fistula (P=0.004, odds ratio=3.802, 95% confidence interval: 1.541-9.383). Conclusions: IFX has been shown to have appreciable effectiveness in Chinese patients with PFCD. MRI is the gold standard for evaluating PFCD, but Van Assche score has some limitations.