title: Anti-TNF therapy is associated with a reduction in radiation exposure in patients with Crohn's disease.
abstract: OBJECTIVE
  Patients with Crohn's disease (CD) are often exposed to ionizing diagnostic radiation with inherent risks from protracted exposure. Meanwhile, bolder definitions of disease control have changed treatment paradigms, with earlier introduction of biological therapy in many. Our aim was to compare the effective radiation dose a year before and 1 and 3 years after initiating anti-tumor necrosis factor (anti-TNF) or corticosteroid therapy.
  
  
  METHODS
  We performed a retrospective review of CD patients treated with anti-TNF (infliximab or adalimumab) or corticosteroids at our institution from 2005 to 2012.
  
  
  RESULTS
  We analyzed 170 patients with CD (114 treated with anti-TNF and 56 treated with corticosteroid). Between the year preceding and the year following therapy, a significant decrease in the mean number of radiology studies (-2.0 vs. -0.2, P=0.001) and the cumulative radiation dose (-3.1 vs. +0.3 mSv, P=0.01) was seen in the anti-TNF group when compared with the steroid group. Between the year preceding therapy and 3 years following therapy, a significant increase in the mean number of radiology studies (+2.3 vs. +0.3, P=0.003) and the cumulative radiation dose (+6.8 vs. +1.3 mSv, P=0.003) was seen in the steroid group when compared with the anti-TNF group. After adjusting for predictors of high diagnostic radiation exposure, the anti-TNF-treated group had a decrease in the number of imaging studies by 2 within a year of therapy (P<0.001).
  
  
  CONCLUSIONS
  Anti-TNF but not corticosteroid therapy is associated with a significant reduction in diagnostic radiation exposure a year after treatment, which persisted after 3 years.
authors.affiliation: Department of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK.
authors.forename: Divya
authors.initials: D
authors.lastname: Aggarwal
authors.forename: Jimmy K
authors.initials: JK
authors.lastname: Limdi
mesh_terms: D000068879:Adalimumab; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab; D007422:Intestines / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D011860:Radiography, Abdominal / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab