The results of seton drainage combined with anti‐<scp>TNF</scp>α therapy for anal fistula in Crohn's disease

Haennig, Audrey; Staumont, G.; Lepage, Benoît; Fauré, Patrick; Alric, Laurent; Buscail, Louis; Bournet, Barbara; Moreau, Jacques

doi:10.1111/codi.12851

Cited by 40 publications

(62 citation statements)

References 26 publications

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“…Seton placement is useful to aid drainage and avoiding sepsis in patients with CD‐pAF and permanent seton drainage has been pursued as a therapeutic option in many patients . While placement is likely to reduce the risk of perianal abscess formation by facilitating constant fistula drainage, the use of seton should be time‐limited for most patients to encourage fistula tract healing.…”

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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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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“…Anti‐tumour necrosis factors (anti‐TNF) are currently used as first line medical treatment, mostly in combination with antibiotics and/or thiopurines . Only infliximab has been recognised to be an effective treatment for active perianal lesions of Crohn's disease .…”

Section: Introductionmentioning

confidence: 99%

“…However, there is still an unmet need in perianal Crohn's disease therapy as sustained remission can only be achieved in half of the patients despite optimal surgical and medical management . In addition, anti‐TNF therapy primary nonresponse, loss of response or intolerance may occur. Therapeutic armamentarium is currently rapidly growing in inflammatory bowel diseases .…”

Section: Introductionmentioning

confidence: 99%

Vedolizumab for perianal Crohn’s disease: a multicentre cohort study in 151 patients

Chapuis-Biron¹,

Bourrier²,

Nachury³

et al. 2020

Aliment Pharmacol Ther

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Summary Background The management of Crohn's disease patients with perianal lesions and anti‐TNF failure is challenging. Aims To assess the effectiveness of vedolizumab in perianal Crohn's disease and the predictors of success in a real‐life cohort. Methods We conducted a nationwide multicentre cohort study in patients with perianal Crohn's disease who received vedolizumab. In patients with active perianal Crohn's disease, the success of vedolizumab was defined by clinical success (no draining fistula at clinical examination and no anal ulcers for primary lesions) at 6 months without medical or surgical treatment for perianal Crohn's disease. Logistic regression analyses were performed to identify predictors of success. In patients with inactive perianal Crohn's disease, recurrence was defined by the occurrence of lesions and/or the need for medical or surgical treatments. Results One hundred and fifty‐one patients were included. Among them 102 patients had active perianal disease, 33 (32.4%) males, mean age 39.8 years, mean Crohn's disease duration 14.6 years; 101 (99%) had received at least one anti‐TNF. The median follow‐up time was 52 weeks. Sixty‐eight per cent of patients discontinued therapy after a median time of 33 weeks. Vedolizumab success was reached in 23/102 (22.5%). Among patients with setons at initiation, 9/61(15%) had a successful removal. In multivariable analysis, factors associated with success were the number of prior biologic agents (≥3, odds ratio, OR: 0.20, 95% CI 0.04‐0.98) and no antibiotics at initiation (OR: 4.76, 95% CI 1.25‐18.19). In 49 patients with inactive perianal Crohn's disease, perianal disease recurred in 15/49 (30.6%), 11/49 (22.4%) needed dedicated treatments. Median time to recurrence was 22 weeks. Conclusions We identified a low rate of success of vedolizumab in patients with active perianal Crohn's disease, and nearly one third of patients with inactive perianal Crohn's disease had perianal recurrence. Further evaluation is warranted in prospective studies.

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“…The initial response was 64%, however complete response rate decreased to 36% in 54 weeks [12]. In similar fashion; Haennig et al, recently reported initial response and complete response rates as 88 % and 75% respectively [15]. This was related with late recurrences, which were unnoticed in early periods of treatment.…”

Section: Discussionmentioning

confidence: 59%

“…Studies, which investigated the results of combined seton and anti-TNF treatment for PFCD, reported a great range of complete response rate between 18-75% (Table IV) [11,12,[15][16][17][18][19][20][21][22][23][24]. Table IV was meticulously prepared only for PFCD.…”

Section: Discussionmentioning

confidence: 99%

Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience

Yardimci¹,

Kara²,

Attaallah³

et al. 2016

MMJ

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The aim of this study was to evaluate the efficacy of combined treatment with anti-tumor necrosis factor (TNF) agents, and setons for perianal fistulas in Crohn's disease.Patients and Methods: Study included 27 consecutive patients with perianal fistulizing Crohn's disease, requiring seton drainage and anti-TNF therapy in our center from January 2013 to November 2014. All patients underwent a standardized pelvic magnetic resonance imaging (MRI) examination. Patient characteristics, follow up time, findings of pelvic MRI, colonoscopy and examination under anesthesia findings were recorded. Response to treatment was evaluated at the end of the follow up. Results:The median follow-up after treatment was 17 months (6-32). The fistula was complex in 24 (89%) of the 27 patients. Colonoscopy revealed ileitis in 16 (59.3%) patients and active proctitis in 9 (33.3%) patients. Perianal abscess was observed in 12 (44.4%) patients. Complete response was obtained in 17 (63%) patients. Only 3 (11.1%) patients experienced recurrence abscess during the study period. We could not find any factor, which were associated with complete response. Conclusion:Complete response was achieved in 63% of the patients, with perianal fistula formation associated with Crohn's disease, with combined seton drainage and anti-TNF therapy.

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The results of seton drainage combined with anti‐TNFα therapy for anal fistula in Crohn's disease

Abstract: Seton drainage for several months combined with infliximab therapy is effective in closing the fistula in 75% of patients with complex perianal fistula formation associated with CD.

Cited by 40 publications

References 26 publications

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

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

Vedolizumab for perianal Crohn’s disease: a multicentre cohort study in 151 patients

Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience

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