Treatment of perianal fistulas in Crohn's disease by local injection of antibody to TNF-α accounts for a favourable clinical response in selected cases: A pilot study

Asteria, C. R.; Ficari, F; Bagnoli, Siro; Milla, Mónica; Tonelli, Francesco

doi:10.1080/00365520600609941

Cited by 74 publications

(37 citation statements)

References 45 publications

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“…A summary of study characteristics is shown in Table 1, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75.…”

Section: Resultsmentioning

confidence: 99%

“…Two prospective studies25 26 assessed responses to EUA and local injection of anti‐TNFα drugs. In one study26, 11 patients received between three and five injections, and eight patients achieved remission (cessation of fistula drainage) at the end of the treatment course.…”

Section: Resultsmentioning

confidence: 99%

“…In one study26, 11 patients received between three and five injections, and eight patients achieved remission (cessation of fistula drainage) at the end of the treatment course. In the second study25, 12 patients with Crohn's anal fistula underwent fistulectomy and local anti‐TNFα injection.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

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BackgroundAnal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula.MethodsA systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS‐I and ROB tool as appropriate.ResultsA total of 1628 citations were reviewed. Sixty‐three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted.ConclusionData describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

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“…Literature about local injections of infliximab for extradermatological indications is increasing. It has essentially been used intralesionally in Crohn’s diseases [10,11,12] and in rheumatoid arthritis [13]. The first reports concern intra-articular infusion of the drug in inflammatory joint diseases and the last report to date is about intravitreal administration for neovascular age-related macular degeneration [14].…”

Section: Discussionmentioning

confidence: 99%

Intralesional Infliximab in Noninfectious Cutaneous Granulomas: Three Cases of Necrobiosis Lipoidica

et al. 2011

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Background: Necrobiosis lipoidica is a rare granulomatous noninfectious skin disease. Treatment of this chronic debilitating disease is of importance because ulceration of the plaques may induce important psychological and physical morbidity. Objective: Infliximab, an anti-TNF-α chimeric monoclonal antibody used intravenously and intralesionally for other extradermatological granulomatous diseases including Crohn’s disease and sarcoidosis, was administered by intradermal injection in necrobiosis lipoidica. The aim of this study was to evaluate the efficacy and safety profile of a locally delivered drug compared to its systemic use. Patients and Methods: Weekly injections of intralesional infliximab for 3 weeks were followed by a 1-week treatment interruption. This treatment schedule was repeated thrice. Results: Two patients who benefitted from complete treatment experienced almost complete remission for up to 18 months. The third patient, who had treatment interruptions, showed partial improvement. No serious side effects were noticed, although the injections caused pain. Conclusions: This is the first report about the efficacy and safety of a therapy consisting of intralesional injections of infliximab for a granulomatous skin disease. Although this approach was clearly effective for necrobiosis lipoidica, the disease recurred several months after treatment interruption, raising the question of the need for maintenance therapy. Further controlled long-term trials are thus necessary.

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“…Uncontrolled, observational pilot studies have been carried out using infliximab [106][107][108] and adalimumab [109,110], and the results are reported as promising. However, the characteristics of these studies do not justify the use of this method in everyday clinical practice.…”

Section: Perianal Fistulasmentioning

confidence: 99%

Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease

Botti

Losco²,

Viganò

et al. 2013

J Ultrasound

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Treatment of perianal fistulas in Crohn's disease by local injection of antibody to TNF-α accounts for a favourable clinical response in selected cases: A pilot study

Abstract: Local injections of infliximab along the fistula tract seem to be an effective and safe treatment of perianal fistulas in Crohn's disease. However, further controlled clinical investigations are warranted.

Cited by 74 publications

References 45 publications

Systematic review of surgical interventions for Crohn's anal fistula

Systematic review of surgical interventions for Crohn's anal fistula

Intralesional Infliximab in Noninfectious Cutaneous Granulomas: Three Cases of Necrobiosis Lipoidica

Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease

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