Local injection of Infliximab for the treatment of perianal Crohn's disease.
OBJECTIVE
Perianal disease is a serious complication of Crohn's disease and its surgical management is still controversial. It has been suggested that the local injection of infliximab has resulted in some potential benefit. This pilot study analyzed the feasibility and safety of such therapy in selected patients with severe perianal Crohn's disease.


METHODS
The study included 15 patients with complex perianal Crohn's disease in which sepsis was not controllable using surgical and medical therapy. Among them, four had previously undergone intravenous infusion of infliximab with no significant response, nine had contraindications for intravenous infusion, and two had associated stenosing ileitis and severe coloproctitis. The injection of 15 to 21 mg of infliximab, associated with surgical treatment, was performed at the internal and external orifices and along the fistula tract. Efficacy was measured by a complete morphologic evaluation using a personal score.


RESULTS
No major adverse effects were reported. Ten of 15 patients healed after 3 to 12 infusions.


CONCLUSIONS
Local injection of infliximab adjacent to the fistula tract of perianal Crohn's disease is safe and may help in fistula healing. A controlled, randomized trial is required to prove the value.
Poggioli
G
G
General Surgery Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy. poggioli@med.unibo.it
Laureti
S
S
Pierangeli
F
F
Rizzello
F
F
Ugolini
F
F
Gionchetti
P
P
Campieri
M
M
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001004:Anus Diseases / Q000188:drug therapy* / Q000209:etiology; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D007279:Injections, Subcutaneous; D018805:Sepsis; D014409:Tumor Necrosis Factor-alpha; D014945:Wound Healing
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab