Long-term outcome of non-fistulizing (ulcers, stricture) perianal Crohn's disease in patients treated with infliximab.
BACKGROUND
In Crohn's disease, anal ulcers and stricture can be disabling.


OBJECTIVE
To evaluate long-term outcome of non-fistulizing perianal Crohn's disease under infliximab.


METHODS
The medical records of 99 patients with non-fistulizing perianal Crohn's disease at first infliximab infusion were reviewed. Complete responses (ulcer healing or stricture regression) after induction infliximab therapy and at the maximal follow-up were assessed.


RESULTS
Ninety-four patients (94.9%) had ulcers, 22 (22.2%) had stricture and 31 (31.3%) had draining perianal fistulas at first infliximab infusion. After infliximab induction therapy, 40/94 (42.5%) patients with ulcers, 4/22 (18.2%) with stricture and 10/31 (32.2%) with fistulas had a complete response. Eight patients were lost to follow-up. After a median follow-up of 175 weeks (range, 13-459), complete response rates for ulcers, stricture and fistulas were 72.3% (68/94), 54.5% (12/22) and 54.8% (20/31) respectively. Long-term response for cavitating ulcer was positively associated with concomitant immunosuppressant use (P = 0.017) and older age (P = 0.049). Among the 12 patients with complete regression of stricture, 6 patients also had anal dilatation. Complete response was associated with perianal pain relief and disappearance of soiling. Three patients with ulcers developed an anal abscess.


CONCLUSIONS
Infliximab therapy may be effective in inducing and maintaining response for ulcers.
Bouguen
G
G
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France.
Trouilloud
I
I
Siproudhis
L
L
Oussalah
A
A
Bigard
M-A
MA
Bretagne
J-F
JF
Peyrin-Biroulet
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003251:Constriction, Pathologic; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000209:etiology; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab