title: Perianal complete remission with combined therapy (seton placement and anti-TNF agents) in Crohn's disease: a Brazilian multicenter observational study.
abstract: BACKGROUND
  Perianal fistulizing Crohn's disease is one of the most severe phenotypes of inflammatory bowel diseases. Combined therapy with seton placement and anti-TNF therapy is the most common strategy for this condition.
  
  
  OBJECTIVE
  The aim of this study was to analyze the rates of complete perianal remission after combined therapy for perianal fistulizing Crohn's disease.
  
  
  METHODS
  This was a retrospective observational study with perianal fistulizing Crohn's disease patients submitted to combined therapy from four inflammatory bowel diseases referral centers. We analyzed patients' demographic characteristics, Montreal classification, concomitant medication, classification of the fistulae, occurrence of perianal complete remission and recurrence after remission. Complete perianal remission was defined as absence of drainage from the fistulae associated with seton removal.
  
  
  CONCLUSIONS
  A total of 78 patients were included, 44 (55.8%) females with a mean age of 33.8 (±15) years. Most patients were treated with Infliximab, 66.2%, than with Adalimumab, 33.8%. Complex fistulae were found in 52/78 patients (66.7%). After a medium follow-up of 48.2 months, 41/78 patients (52.6%) had complete perianal remission (95% CI: 43.5%-63.6%). Recurrence occurred in four (9.8%) patients (95% CI: 0.7%-18.8%) in an average period of 74.8 months.
  
  
  CONCLUSIONS
  Combined therapy lead to favorable and durable results in perianal fistulizing Crohn's disease.
authors.affiliation: Unidade de Cirurgia Colorretal, Hospital Universitário Cajuru, Universidade Católica do Paraná - PUCPR, Curitiba, PR, Brasil.
authors.forename: Paulo Gustavo
authors.initials: PG
authors.lastname: Kotze
authors.affiliation: Unidade de Doenças Inflamatórias Intestinais, Hospital Heliópolis, São Paulo, SP, Brasil.
authors.forename: Idblan Carvalho de
authors.initials: IC
authors.lastname: Albuquerque
authors.affiliation: Unidade de Cirurgia Colorretal, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil.
authors.forename: André
authors.initials: A
authors.lastname: da Luz Moreira
authors.affiliation: Unidade de Cirurgia Colorretal, Hospital Universitário Cajuru, Universidade Católica do Paraná - PUCPR, Curitiba, PR, Brasil.
authors.forename: Wanessa Bertrami
authors.initials: WB
authors.lastname: Tonini
authors.affiliation: Unidade de Cirurgia Colorretal, Hospital Universitário Cajuru, Universidade Católica do Paraná - PUCPR, Curitiba, PR, Brasil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Olandoski
authors.affiliation: Unidade de Cirurgia Colorretal, Universidade de Campinas - UNICAMP, Campinas, SP, Brasil.
authors.forename: Claudio Saddy Rodrigues
authors.initials: CS
authors.lastname: Coy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha