Long-term Outcome of Perianal Fistulizing Crohn's Disease Treated With Infliximab

Abstract

About two-thirds of patients with fistulizing perianal Crohn's disease had fistula closure, and one-third had fistula recurrence after infliximab initiation. Combination therapy, duration of seton drainage less than 34 weeks, and long-term treatment with infliximab were associated with better outcomes.

Placebo Response Rate in Clinical Trials of Fistulizing Crohn's Disease: Systematic Review and Meta-analysis

“…In addition, cessation of drainage from fistulae ('closure') does not equate to healing, since MRI scanning will generally show persistent fistulous tracks even when drainage ceases. 29 It can also be argued that RCTs examine medical therapy to the exclusion of surgical management, although in clinical practice combined medical and surgical management, particularly seton insertion, 30 is the standard of care. 3 Despite the detailed analyses we conducted, it is important to point out that, without access to individual patient level data, it is difficult to draw any firm conclusions about specific patient characteristics that may predict a response to placebo in patients with fistulizing CD.…”

Induction and Maintenance Infliximab Therapy for the Treatment of Crohn’s Disease with Perianal Fistulas in Children: Retrospective, Multicenter Study

“…Biological treatment with TNF-alfa inhibitors improve the condition of intestinal mucosa, and diminish the number of hospital admissions and surgeries [20,26]. The results of the treatment of fistulas are also improved [6,13,17,19,[27][28][29][30][31]. However, there is a lack of credible studies on the prevention of fistulas in Crohn's disease in children.…”

“…Great expectations are connected to biological treatment. Numerous authors analyzing the results of infliximab therapy in adults with Crohn's disease observed that in more than a half of the patients fistulas were completely closed after induction therapy; slightly worse results were seen after maintenance therapy [19,27,29,30,35,36]. Crandall et al [37] obtained good results with infliximab in treating Crohn's disease with fistulas in children at 54 th week of the treatment.…”

Indian Society of Gastroenterology consensus statements on Crohn’s disease in India

“…In short-term treatment, anti-TNF antibodies were significantly better than placebo in healing and closure of fistulae with a relative response rate of 2.44 (95 % CI 1.13-5.28) [105]. Recent studies with longer-term follow up indicate that one third of enterocutaneous fistulae and up to two thirds of perianal fistulae heal with infliximab, with closure being associated with longer-term treatment [108,109]. Fistula recurrence was noted in a significant number on follow up.…”