Long-term outcome of infliximab combined with surgery for perianal fistulizing Crohn's disease

Abstract

Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD, and this treatment was associated with better long-term outcomes.

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

“…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 . 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.…”

“…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. This study perhaps mimics the presumed ideal multimodality approach applied in a rapid time period following diagnosis of fistula underpinned by focus of MRI-guided clearance of sepsis and very rapid initiation of anti-TNFs to control the inflammatory process and early removal of setons to facilitate closure of the tract and this may explain the excellent results.…”

Understanding the complications of anti‐tumor necrosis factor therapy in East Asian patients with inflammatory bowel disease

“…CD patients who received immunomodulator had a higher incidence (95% confidence interval [CI]) of malignancy compared with those without immunomodulator use (1.84 [0. 22,6.66]/100 patient-years vs 0.00 [0.00, 0.00]/100 patient-years).…”

“…5 A prospective study in China showed that the group treated with infliximab had favorable long-term efficacy, with significantly decreased CDAI score, C-reactive protein level, and erythrocyte sedimentation rate, compared with the subjects' pretreatment levels (P < 0.01). 6 A retrospective study conducted in Korea compared the efficacy of infliximab with that of cyclosporine in patients with severe steroid-refractory UC. While no difference was found between the treatments in preventing colectomy, infliximab with azathioprine seemed to be superior to cyclosporine monotherapy when it comes to preventing colectomy.…”

Infliximab for the treatment of Crohn’s disease

“…Data on clinical applications of IFX for the treatment of CD in Chinese patients are limited. Previous studies in Chinese CD patients showed that treatment with three infusions of 5 mg/kg IFX was effective for induction of remission in active and complex CD patients who failed to respond to conventional treatment [8]; IFX therapy induced remission in ∼ 50% of CD patients [9]; and IFX combined with surgery was effective and safe for perianal fistulizing CD [10].…”