Long-term treatment of rectovaginal fistulas in Crohn's disease: response to infliximab in the ACCENT II Study.
OBJECTIVE
The ACCENT II study (A Crohn's Disease Clinical Trial Evaluating Infiximab in a New Long-term Treatment Regimen in Patients With Fistulizing Crohn's Disease) evaluated the efficacy and safety of infliximab maintenance treatment in patients with fistulizing Crohn's disease. This post hoc analysis was conducted to determine the efficacy and safety of infliximab therapy in women with rectovaginal fistulas.


METHODS
All patients received 5 mg/kg infliximab intravenously at weeks 0, 2, and 6. Patients who achieved response at weeks 10 and 14 then were randomized as responders if they had at least 50% of baseline fistulas closed, or as nonresponders, to receive placebo or infliximab 5 mg/kg every 8 weeks through week 54.


RESULTS
Of 282 patients in the ACCENT II study, 25 of 138 (18.1%) women had a total of 27 draining rectovaginal fistulas at baseline. After infusions of infliximab at weeks 0, 2, and 6, 60.7% (17 of 28) and 44.8% (13 of 29) of rectovaginal fistulas were closed at weeks 10 and 14, respectively. Among responders, 72.2% (13 of 18) of rectovaginal fistulas were no longer draining at week 14. The duration of rectovaginal fistula closure was longer in the infliximab 5-mg/kg maintenance group (median, 46 wk) than in the placebo group (33 wk).


CONCLUSIONS
Infliximab is effective in short-term closure of rectovaginal fistulas and maintenance treatment was more effective than placebo in prolonging rectovaginal fistula closure.
Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. bsands@partners.org
Bruce E
BE
Sands
Marion A
MA
Blank
Kam
K
Patel
Sander J
SJ
van Deventer
D018784:Abdominal Abscess / Q000139:chemically induced; D015746:Abdominal Pain / Q000139:chemically induced; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018771:Arthralgia / Q000139:chemically induced; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006261:Headache / Q000139:chemically induced; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D009325:Nausea / Q000139:chemically induced; D011788:Quality of Life; D012006:Rectovaginal Fistula / Q000209:etiology / Q000517:prevention & control*; D012141:Respiratory Tract Infections / Q000139:chemically induced
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab