title: [Infliximab therapy for Crohn's disease anoperineal lesions].
abstract: OBJECTIVE
  To retrospectively evaluate the efficacy, the duration of response, and the tolerance of Remicade in anoperineal Crohn's disease.
  
  
  METHODS
  Fifty patients with severe symptomatic and refractory anoperineal Crohn's lesions (38 fistulae and 29 cavitating ulcers and superficial fissures) were treated with 3 intravenous infusions of Remicade (5 mg/kg) at weeks 0, 2 and 6. Efficacy was assessed using Allan's functional score and proctologic examination at 8 weeks (W8) and 24 weeks (W24) after the first infusion.
  
  
  RESULTS
  At W8, a response was noted for 71% (27/38) of fistulae and 79% (23/29) of ulcers and fissures. Healing rates were 39% and 49%, respectively. Efficacy of Remicade at W8 did not vary according to sex, number and type of fistulae and other treatments. At W24, 58% (15/26) of patients with fistulae and 63% (10/16) of patients with ulcers or fissures had a response. The response rate at W24 was higher in patients having anoperineal Crohn's lesions for less than one year: 77% vs 32% (P=0.004). Median Allan's score significantly decreased from 3.9 before treatment to 1.7 at W2 (P<0.001), 1.3 at W6 and 0.8 at W8. Median duration of response was 9.5 months (range: 0.5-12.5) after last infusion and was not influenced by associated treatments including immunomodulators. The relapse rate at 1 year was 64% for the responders followed at least one year (n=21). Minor adverse events occurred during 12% of all infusions. Eight patients had an infection, including one pneumonia. Eight patients developed a perineal abscess 16 weeks (range: 4-32) after the first infusion.
  
  
  CONCLUSIONS
  Remicade is rapidly effective and well tolerated in anoperineal Crohn's lesions, but the high relapse rate stresses the need for long term therapeutic strategies in these patients.
authors.affiliation: Services d'Hépato-Gastroentérologie, CHU, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Ouraghi
authors.forename: S
authors.initials: S
authors.lastname: Nieuviarts
authors.forename: J L
authors.initials: JL
authors.lastname: Mougenel
authors.forename: M
authors.initials: M
authors.lastname: Allez
authors.forename: M
authors.initials: M
authors.lastname: Barthet
authors.forename: F
authors.initials: F
authors.lastname: Carbonnel
authors.forename: J
authors.initials: J
authors.lastname: Cosnes
authors.forename: J P
authors.initials: JP
authors.lastname: Gendre
authors.forename: B
authors.initials: B
authors.lastname: Flourié
authors.forename: J J
authors.initials: JJ
authors.lastname: Meurisse
authors.forename: P
authors.initials: P
authors.lastname: Quandalle
authors.forename: O
authors.initials: O
authors.lastname: Ernst
authors.forename: M
authors.initials: M
authors.lastname: Lemann
authors.forename: A
authors.initials: A
authors.lastname: Cortot
authors.forename: R
authors.initials: R
authors.lastname: Modigliani
authors.forename: J F
authors.initials: JF
authors.lastname: Colombel
mesh_terms: D000038:Abscess / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D001004:Anus Diseases / Q000188:drug therapy* / Q000209:etiology; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy / Q000209:etiology; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D010502:Perineum; D012003:Rectal Fistula / Q000188:drug therapy / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab