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. Objectives -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.

The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study

“…The potential reasons for higher closure rates in our study could be explained by the early intervention with biologics after initial surgery (median time to initiation of anti‐TNFs only 6 weeks) and the removal of seton in a significant proportion of patients facilitating closure of the fistula tract. Our results are similar to a recent small Brazilian multicentre study using combined therapy of seton placement and anti‐TNFs agent which reported a complete perianal remission in 52% of patients . The highest fistula closure rates reported so far is from a single‐centre study from China, which reported 89.3% (25/28) clinical closure rates at week 30 using multimodality treatment .…”

“…Our results are similar to a recent small Brazilian multicentre study using combined therapy of seton placement and anti-TNFs agent which reported a complete perianal remission in 52% of patients. 23 The highest fistula closure rates reported so far is from a single-centre study from China, which reported 89.3% (25/28) clinical closure rates at week 30 using multimodality treatment. 24 In this study, preoperative MRI was used to guide drainage of all cavities by EUA followed by a rapid initiation of anti-TNF within 1 week after surgery followed by early removal of setons.…”

Treatment of perianal fistula in Crohn's disease: a systematic review and meta‐analysis comparing seton drainage and anti‐tumour necrosis factor treatment

“…Also, four studies directly comparing (combined) anti‐TNF and seton drainage on closure and recurrence rates were analysed separately . Finally, 34 cohort studies and case‐series on anti‐TNF treatment were analysed .…”

A series of seton techniques involving "top-down therapy" for patients with Crohn's disease who initially presented with perianal fistulas

“…After seton drainage, an aggressive top-down strategy was advocated instead of a step-up approach, supported by evidence that the early use of BIOs induces higher remission rates for anorectal complex fistulas associated with CD 15,24) . Ma et al 25) mentioned that the early initiation of IFX or ADA within the first 2 years of diagnosis reduces the rate of surgery and secondary loss of response, which requires dose escalation.…”