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

Abstract

Background. Infliximab is a biological drug used for the treatment of Crohn's disease in children. Objectives. The aim of this retrospective study was the estimation of effectiveness and safety of infliximab in the treatment of Crohn's disease with perianal fistulas in children. Material and Methods. Analysis comprised 50 children with Crohn's disease with perianal fistulas aged 9 to 18 years (16 girls and 34 boys) who failed to respond to conventional therapy. The children were divided into two groups: the first group contained 23 children with simple fistulas and the second -27 children with complex fistulas. All children were treated with infliximab, administered in the dose of 5 mg per kilogram of the body mass. In the induction phase infliximab was administered at weeks 0, 2 and 6 and after clinical response in maintenance phase the drug was administered every 8 weeks; together for 12 months. Results. In 76% of children after induction therapy with infliximab and in 71.87% after maintenance therapy the complete closure of fistula occurred. During the first year after the treatment a recurrence of a fistula was observed in 30.43% of the children. In two children anaphylactic shock was observed during injection of infliximab. The remaining children tolerated the drug well. Conclusions. The treatment with infliximab was effective in the majority of fistulazing Crohn's disease and caused the closure of perianal fistula which improved quality of life (Adv Clin Exp Med 2016, 25, 3, 523-530).

Perianal Crohn's Disease in Children and Adolescents

“…32,33 In a retrospective multicenter study on 50 patients with pediatric perianal Crohn's disease, infliximab was effective and safe as 72% of patients had a complete closure of fistulas, while 30% had a fistula recurrence during the first year after treatment. 4 In children, anti-TNF-α is recommended to be continued for at least 1 year following abscess drainage. 5 The combination of infliximab and seton placement in the treatment of perianal fistulas has been shown to result in better primary treatment results, longer effect duration and lower recurrence rate compared with either treatment alone.…”

“…2,3 The main management goals for the perianal Crohn's disease are long-term remission and prevention of complications (such as recurrent perianal sepsis, chronic fistula formation, strictures, and fecal incontinence), limitation of adverse effect on growth and development, hospital admissions, and the need for surgical procedures, as well as improvement of quality of life. 4,5 These goals are best achieved by multidisciplinary approach with combined pharmacological and surgical measures depending on the inflammatory activity, abscess formation, location, and clinical course of the perianal disease.…”

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

“…Of these, 166 were included in the full text review. Seventy‐six were further excluded, leaving 90 studies for data extraction [17–106] (Figure 1). Of the 90 studies, there were 53 retrospective studies, 16 prospective observational studies, 16 RCTs, four case series and one cross‐sectional study.…”

Effectiveness of Biological Agents in the Treatment of Pediatric Patients with Crohn’s Disease and Anal Fistulae

“…In addition, early introduction of IFX was effective for maintenance of longterm remission in 14 out of 15 patients [17]. A retrospective observational study at another institution [18] that examined the efficacy of IFX for patients with CD with anal fistula stated that the anal fistula was closed in 70% of patients and highlighted the efficacy of IFX in such patients. Similarly, in our study, closure of the anal fistula was confirmed in all 7 patients using IFX, and there was no recurrence.…”