Combining infliximab, anti-MAP and hyperbaric oxygen therapy for resistant fistulizing Crohn's disease

Abstract

Background:Fistulizing Crohn's disease (CD) presents a therapeutic challenge as fistulae are notoriously difficult to heal. Mycobacterium avium ss paratuberculosis (MAP) treatment in CD is gaining attention.Aim:We evaluated healing of CD fistula(e) using a novel combination therapy.Study:Nine consecutive patients who failed to heal fistulae on conventional treatment including anti-TNF, were treated with at least three doses of infliximab, 18–30 courses of hyperbaric oxygen therapy and anti-MAP antibiotics comprising rifabutin, clarithromycin and clofazimine.Results:All patients achieved complete healing of fistulae by 6–28 weeks and follow-up for mean 18 months.Conclusion:Combining infliximab, hyperbaric oxygen therapy and anti-MAP, seems to enable healing of recalcitrant fistulae and although a small case series, all nine patients achieved complete healing.

Profound remission in Crohn’s disease requiring no further treatment for 3–23 years: a case series

“…The combination antibiotic therapy was personalised according to factors, such as allergies, fistulae, severity of presentation and initial response to three antibiotics. In four patients, AMAT was combined with infliximab (mean 6 infusions) to accelerate fistula healing, as shown in one analysis using combination therapy [26]. One patient achieved deep mucosal healing with AMAT alone.…”

“…A proposition, based on multiple studies, is that immunosuppressives actually work in CD by their secondary antibiotic action on MAP [36][37][38]. Interestingly, anti-TNF α agents have been shown to reduce Mycobacterial survivability and may be a key reason why they work well with AMAT to accelerate healing [39], especially that of Crohn's fistulae [26]. Though a caveat to this is that they may lead to resistance of MAP, where it resides in tissues [40].…”

Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn’s disease

“…Positive outcomes with hyperbaric oxygen therapy for treating perineal Crohn's disease have been reported in small case series 11,16,17 . However, patient characteristics and outcome parameters were not well defined in these studies, leading to a significant risk of bias.…”

Welcome to volume 2 of Future Science OA

“…Gaurav Agrawal, Thomas Borody and colleagues (Centre for Digestive Diseases, Australia) presented a case report evaluating a novel combination therapy for resistant fistulizing Crohn's disease [7]. …”