title: Infliximab: lack of efficacy on perforating complications in Crohn's disease.
abstract: BACKGROUND
  Infliximab (Remicade), a chimeric monoclonal antibody against tumor necrosis factor alpha (TNF-alpha), has emerged as promising therapeutic option in perianal fistulizing Crohn's disease (CD). However, little knowledge exists about its use for the treatment of internal fistulas in CD. We present our experience with infliximab in this situation.
  
  
  METHODS
  Four patients with CD who had internal fistulas (Case 1: entero-enteral and entero-abdominal; Case 2: entero-enteral; Case 3: entero-enteral and parastomal; Case 4: entero-vesical) were treated with 3 infusions of infliximab (5 mg/kg body weight) with intervals of 2 and 4 weeks. In addition, 3 patients had strictures and 2 patients had perianal fistulas.
  
  
  RESULTS
  After the three infusions of infliximab (5 mg/kg body weight), internal fistulas remained unchanged in all patients. The perianal fistulas present in 2 cases were healed. Administration of infliximab was safe and well tolerated in all cases.
  
  
  CONCLUSIONS
  Treatment with 3 infusions of infliximab (5 mg/kg body weight) led to healing of only the perianal fistulas, whereas the internal fistulas were not influenced. We conclude that in these 4 cases, infliximab was well tolerated but not effective for the management of internal fistulas and was no alternative for surgery.
authors.affiliation: Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, University of Vienna, Vienna, Austria. wolfgang.miehsler@chello.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Miehsler
authors.forename: Walter
authors.initials: W
authors.lastname: Reinisch
authors.forename: Lili
authors.initials: L
authors.lastname: Kazemi-Shirazi
authors.forename: Clemens
authors.initials: C
authors.lastname: Dejaco
authors.forename: Gottfried
authors.initials: G
authors.lastname: Novacek
authors.forename: Peter
authors.initials: P
authors.lastname: Ferenci
authors.forename: Friedrich
authors.initials: F
authors.lastname: Herbst
authors.forename: Judith
authors.initials: J
authors.lastname: Karner
authors.forename: Béla
authors.initials: B
authors.lastname: Téleky
authors.forename: Ewald
authors.initials: E
authors.lastname: Schober
authors.forename: Harald
authors.initials: H
authors.lastname: Vogelsang
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D000069285:Infliximab; D007262:Infusions, Intravenous; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012003:Rectal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab