title: [Efficacy of tumor necrosis factor-alpha inhibitors in fistulising perianal Crohn's disease].
abstract: BACKGROUND
  Tumor necrosis factor-alpha inhibitors are increasingly used in the treatment of severe Crohn's disease.
  
  
  OBJECTIVE
  The aim of the authors was to assess retrospectively the short and long term efficacy of tumor necrosis factor-alpha inhibitors in fistulising Crohn's disease.
  
  
  METHODS
  Responses to therapy was determined using Crohn's Disease Activity Index, Perianal Disease Activity Index, the rate of complete fistula closure and the additional surgical procedures during biological therapy.
  
  
  RESULTS
  After 12 weeks the perianal activity was decreased in more than 80% of the cases, and the complete remission rate was about 60%. After one year of therapy about one third of the patients had fistula closure, but after cessation of the biological therapy recurrence of fistulas was detected in every second patient. In most cases additional immunosuppressive therapy was necessary during biological treatment. During the one-year therapy period additional surgical treatments were performed in 45% of patients; seton insertion and abscess drainage were the most frequent procedures.
  
  
  CONCLUSIONS
  Tumor necrosis factor-alpha inhibitor therapy is effective in the treatment of perianal Crohn's disease, however, additional immunosuppressive drugs and rectum sparing surgical procedures were necessary during the one-year treatment period. Because of the high rate of fistula recurrence, long term tumor necrosis factor-alpha treatment may be useful.
authors.affiliation: Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8-10. 6720.
authors.forename: Renáta
authors.initials: R
authors.lastname: Bor
authors.forename: Klaudia
authors.initials: K
authors.lastname: Farkas
authors.forename: Anita
authors.initials: A
authors.lastname: Bálint
authors.forename: Mónika
authors.initials: M
authors.lastname: Szűcs
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Abrahám
authors.forename: Gellért
authors.initials: G
authors.lastname: Baradnay
authors.forename: Tibor
authors.initials: T
authors.lastname: Wittmann
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szepes
authors.forename: Ferenc
authors.initials: F
authors.lastname: Nagy
authors.forename: Tamás
authors.initials: T
authors.lastname: Molnár
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology* / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology / Q000628:therapy; D004322:Drainage; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007412:Intestinal Fistula / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D012003:Rectal Fistula / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
keywords: adalimumab; biological therapy; biológiai kezelés; infliximab; perianal Crohn’s disease; perianalis Crohn-betegség; perianalis fisztula