Efficacy of combined anti-TNF-alpha and surgical therapy in perianal and enterocutaneous fistulizing Crohn's disease--clinical observations from a tertiary Eastern European center.
OBJECTIVE
Recently, anti-TNF-alpha therapy has increasingly been used in the treatment of perianal Crohn's disease (PCD), but there is only limited data regarding its short- and long-term efficacy.


METHODS
The medical records of 68 patients treated with anti-TNF-alpha for PCD were assessed retrospectively. Rate of complex fistulas was 75%. Every patient received induction therapy, but in 20 cases the treatment was discontinued before week 52 due to funding regulations, an allergic reaction, or compliance problems. On week 12, the luminal activity decreased in more than 80% of the cases and the complete remission (CR) rate was about 60%; by the end of the first year, this ratio did not change substantially. Complete fistula closure was achieved in 26 cases (38.3%) and 53 patients (51.5%) showed a partial response during the 1-year period. Regarding both perianal and luminal activities, CR rate was achieved in 23 cases (33.8%). However, after the biological therapy was discontinued, recurrence of fistulas could be detected in every second patient. Additional surgical intervention was performed in 45% of patients during the 1-year period (seton drainage of fistulas and abscess drainage).


CONCLUSIONS
The anti-TNF-alpha therapy combined with surgery is an effective treatment of PCD. Approximately every third patient revealed complete fistula closure, while half of the other cases showed a partial response. Due to the high rate of fistula recurrence after stopping the biological therapy, more than 1 year of anti-TNF-α treatment may be beneficial.
First Department of Medicine, University of Szeged , Szeged , Hungary.
Renáta
R
Bor
Klaudia
K
Farkas
Anita
A
Bálint
Mónika
M
Szucs
Szabolcs
S
Ábrahám
Gellért
G
Baradnay
Tibor
T
Wittmann
Zoltán
Z
Szepes
Ferenc
F
Nagy
Tamás
T
Molnár
D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001691:Biological Therapy; D002648:Child; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery*; D004322:Drainage; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010502:Perineum; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D012044:Regression Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014945:Wound Healing / Q000187:drug effects; D055815:Young Adult
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
adalimumab; biological therapy; infliximab; perianal Crohn’s disease