Efficacy of combined anti-TNF-alpha and surgical therapy in perianal and enterocutaneous fistulizing Crohn's disease--clinical observations from a tertiary Eastern European center

• Published in: Scandinavian journal of gastroenterology Vol. 50; no. 2; p. 182
• Main Authors: Bor, Renáta, Farkas, Klaudia, Bálint, Anita, Szucs, Mónika, Ábrahám, Szabolcs, Baradnay, Gellért, Wittmann, Tibor, Szepes, Zoltán, Nagy, Ferenc, Molnár, Tamás
• Format: Journal Article
• Language: English
• Published: England 01.02.2015
• Subjects: Adalimumab; Adolescent; Adult; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Biological Therapy; Child; Combined Modality Therapy; Crohn Disease - drug therapy; Crohn Disease - surgery; Drainage; Female; Gastrointestinal Agents - therapeutic use; Humans; Infliximab; Intestinal Fistula - surgery; Male; Middle Aged; Perineum; Rectal Fistula - surgery; Recurrence; Regression Analysis; Remission Induction; Retrospective Studies; Tertiary Care Centers; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Wound Healing - drug effects; Young Adult; perianal Crohn’s disease; biological therapy; infliximab; adalimumab
• ISSN: 1502-7708
• DOI: 10.3109/00365521.2014.936033

Recently, anti-TNF-alpha therapy has increasingly been used in the treatment of perianal Crohn's disease (PCD), but there is only limited data regarding its short- and long-term efficacy. The medical records of 68 patients treated with anti-TNF-alpha for PCD were assessed retrospectively. Rate of complex fistulas was 75%. Every patient received induction therapy, but in 20 cases the treatment was discontinued before week 52 due to funding regulations, an allergic reaction, or compliance problems. On week 12, the luminal activity decreased in more than 80% of the cases and the complete remission (CR) rate was about 60%; by the end of the first year, this ratio did not change substantially. Complete fistula closure was achieved in 26 cases (38.3%) and 53 patients (51.5%) showed a partial response during the 1-year period. Regarding both perianal and luminal activities, CR rate was achieved in 23 cases (33.8%). However, after the biological therapy was discontinued, recurrence of fistulas could be detected in every second patient. Additional surgical intervention was performed in 45% of patients during the 1-year period (seton drainage of fistulas and abscess drainage). The anti-TNF-alpha therapy combined with surgery is an effective treatment of PCD. Approximately every third patient revealed complete fistula closure, while half of the other cases showed a partial response. Due to the high rate of fistula recurrence after stopping the biological therapy, more than 1 year of anti-TNF-α treatment may be beneficial.