Long-Term Outcome of Enterocutaneous Fistula in Patients With Crohn's Disease Treated With Anti-TNF Therapy: A Cohort Study from the GETAID

Abstract

In CD patients with ECF, anti-TNF therapy may be effective in up to one-third of patients, especially in the absence of stenosis and complex fistula. A careful selection of patients is mandatory to prevent treatment failure and improves the safety.

Effect of Adalimumab on an Enterocutaneous Fistula in Patients with Crohn's Disease: A Case Series

“…However, thus far, the efficacy of anti-TNF-α agents for enterocutaneous fistula remains unclear, because many cases in those trials were patients with perianal fistulizing CD. Recently, Amiot and colleagues retrospectively reviewed the outcome of patients with CD with enterocutaneous fistulas, excluding perianal fistulas, treated with anti-TNF-α agents (9). In that report, it was concluded that anti-TNF-α therapy may be effective in up to one-third (33%) of patients and the results strengthened the viewpoint that the concomitant use of steroids, an association with stenosis, and a fistula with multiple tracts are significant predictors of anti-TNF-α therapy failure (9).…”

“…Recently, Amiot and colleagues retrospectively reviewed the outcome of patients with CD with enterocutaneous fistulas, excluding perianal fistulas, treated with anti-TNF-α agents (9). In that report, it was concluded that anti-TNF-α therapy may be effective in up to one-third (33%) of patients and the results strengthened the viewpoint that the concomitant use of steroids, an association with stenosis, and a fistula with multiple tracts are significant predictors of anti-TNF-α therapy failure (9). Although this case series included only three cases, we also demonstrated that one of three cases (33%) showed complete remission of the enterocutaneous fistula and maintained closure for more than 16 months with ADA and azathioprine therapy.…”

“…However, since IFX is reported to produce rapid fistula (perianal fistula) closure in approximately two-thirds of patients, IFX is currently considered to be a possible alternative to surgery for patients with perianal disease (8). However, with regard to enterocutaneous fistulas very few reports thus far have described the efficacy of anti-TNF-α agents (9). In particular, studies focusing on the efficacy of ADA for patients with CD with enterocutaneous fistulas are very rare (10).…”

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.…”

Comparative Study of Two Cohorts of Newly Diagnosed Crohn's Disease Demonstrates Change in Therapeutic Strategies

“…The immunomodulators, azathioprine and 6-mercaptopurine, are considered a mainstay for sparing steroid use and for maintaining remission in CD [7,8,9]. The introduction of the monoclonal antibodies targeting tumor necrosis factor-alpha improved CD treatment, providing an effective therapeutic option for patients with refractory and fistulizing CD, lowering hospitalization and surgery rates and modifying disease course and outcomes [7,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24]. Furthermore, pivotal studies supported the benefit of a “top-down” strategy [15,19].…”