Infliximab and surgical treatment of complex anal Crohns disease

Colorectal Disease, 05/08/2012

The response rates of Crohn’s related complex perianal fistulae to infliximab are good. Complete response is associated with a reduced need for surgical intervention.

Methods

  • A prospectively maintained database was used to identify patients with Crohn’s disease and complex anal fistulae who were treated with infliximab (primary treatment - 3 initial infusions followed by maintenance therapy).
  • Patients who received infliximab for luminal disease or for enterocutaneous, peristomal or rectovaginal fistulae were excluded from this study.

Results

  • Fifty-two patients (25 male, median age 24 (range 15-72) were treated with infliximab for perianal Crohn’s fistulae for a median of 66 months (range 7-124 months).
  • Twenty-six of the patients underwent pre-infliximab MRI scans and thirty-eight had an EUA prior to commencement of treatment, 22 of whom had seton(s) inserted into their fistulae.
  • Maintenance therapy was possible in 42 of 52 patients (81%).
  • Twenty-two patients (42.3%) had a complete response to treatment, 23 (44.2%) had a partial response and 7 (13.5%) had no response.
  • Less than complete response to infliximab was associated with a greater risk of requiring surgical intervention (Fisher’s exact test, df 1, p=0.005).

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