Combined approach with infliximab, surgery, and methotrexate in severe fistulizing anoperineal Crohnʼs disease: Results from a prospective study

Roumeguère, P.; Bouchard, D.; Pigot, F.; Castinel, A.; Juguet, F.; Gaye, Delphine; Capdepont, Maylis; Zerbib, Frank; Laharie, David

doi:10.1002/ibd.21405

Cited by 51 publications

(45 citation statements)

References 39 publications

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“…The percentage of anorecto-vaginal fistulas in our study (20.4%) was higher than that described in the first study but similar to the most recent ones[34-36]. Our clinical remission rate was slightly higher than those in other studies, probably due to our longer follow-up period and longer duration of anti-TNF-α treatment[8,18,22,23,37]. Additionally, it might also be related to longer seton drainage time as setons were removed after completion of induction treatment.…”

Section: Discussionsupporting

confidence: 79%

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin¹,

Armengol-Debeir²,

Charpentier³

et al. 2017

WJG

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AIMTo evaluate the imaging course of Crohn’s disease (CD) patients with perianal fistulas on long-term maintenance anti-tumor necrosis factor (TNF)-α therapy and identify predictors of deep remission.METHODSAll patients with perianal CD treated with anti-TNF-α therapy at our tertiary care center were evaluated by magnetic resonance imaging (MRI) and clinical assessment. Two MR examinations were performed: at initiation of anti-TNF-α treatment and then at least 2 years after. Clinical assessment (remission, response and non-response) was based on Present’s criteria. Rectoscopic patterns, MRI Van Assche score, and MRI fistula activity signs (T2 signal and contrast enhancement) were collected for the two MR examinations. Fistula healing was defined as the absence of T2 hyperintensity and contrast enhancement on MRI. Deep remission was defined as the association of both clinical remission, absence of anal canal ulcers and healing on MRI. Characteristics and imaging patterns of patients with and without deep remission were compared by univariate and multivariate analyses.RESULTSForty-nine consecutive patients (31 females and 18 males) were included. They ranged in age from 14-70 years (mean, 33 years). MRI and clinical assessment were performed after a mean period of exposure to anti-TNF-α therapy of 40 ± 3.7 mo. Clinical remission, response and non-response were observed in 53.1%, 20.4%, and 26.5% of patients, respectively. Deep remission was observed in 32.7% of patients. Among the 26 patients in clinical remission, 10 had persisting inflammation of fistulas on MRI (T2 hyperintensity, n = 7; contrast enhancement, n = 10). Univariate analysis showed that deep remission was associated with the absence of rectal involvement and the absence of switch of anti-TNF-α treatment or surgery requirement. Multivariate analysis demonstrated that only the absence of rectal involvement (OR = 4.6; 95%CI: 1.03-20.5) was associated with deep remission.CONCLUSIONDeep remission is achieved in approximately one third of patients on maintenance anti-TNF-α therapy. Absence of rectal involvement is predictive of deep remission.

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Section: Discussionsupporting

confidence: 79%

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin¹,

Armengol-Debeir²,

Charpentier³

et al. 2017

WJG

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“…28,30 Secondly, an increasing proportion of patients become methotrexate-refractory with time. 28,30,31 This secondary loss of response to methotrexate could be related to partial efficacy of the drug, characterised by symptom relief without complete mucosal healing, as suggested here. The route of administration probably cannot explain the low rate of complete endoscopic healing observed as all the included patients were treated parenterally (subcutaneous and ⁄ or intramuscular).…”

Section: Discussionmentioning

confidence: 69%

Mucosal healing with methotrexate in Crohn’s disease: a prospective comparative study with azathioprine and infliximab

Laharie

Reffet

Belleannée

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

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“…In a further multimodal therapy study of 81 patients in France where setons were placed for a median of only 3.8 months, an overall closure rate of 75.3% was achieved . In another study using multimodal treatment where setons were removed between the second and third dose of infliximab, and patients were treated with infliximab and methotrexate, a short‐term response rate of 85 % and a 1‐year response rate of 50% were achieved . Obviously, some patients may develop recurrent abscess following seton removal, and hence, early and direct access to coloproctologists for these patients who develop recurrent abscess is mandatory.…”

Section: Discussionmentioning

confidence: 99%

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

Scheer

Black

Pugliese³

et al. 2018

Aliment Pharmacol Ther

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Combined approach with infliximab, surgery, and methotrexate in severe fistulizing anoperineal Crohnʼs disease: Results from a prospective study

Abstract: A combined approach with infliximab induction, two surgical sphincter-sparing steps and methotrexate is effective in achieving short-term response in severe fistulizing anoperineal CD. The best maintenance regimen remains to be determined.

Cited by 51 publications

References 39 publications

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Mucosal healing with methotrexate in Crohn’s disease: a prospective comparative study with azathioprine and infliximab

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

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