Efficacy of combined anti-TNF-alpha and surgical therapy in perianal and enterocutaneous fistulizing Crohn's disease - Clinical observations from a tertiary Eastern European center

Renáta Bor, Klaudia Farkas, Anita Bálint, Mónika Szucs, Szabolcs Ábrahám, Gellért Baradnay, T. Wittmann, Zoltán Szepes, F. Nagy, T. Molnár

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and aims. Recently, anti-TNF-alpha therapy has increasingly been used in the treatment of perianal Crohn's disease (PCD), but there is only limited data regarding its short- and long-term efficacy. Material and methods. The medical records of 68 patients treated with anti-TNF-alpha for PCD were assessed retrospectively. Rate of complex fistulas was 75%. Every patient received induction therapy, but in 20 cases the treatment was discontinued before week 52 due to funding regulations, an allergic reaction, or compliance problems. On week 12, the luminal activity decreased in more than 80% of the cases and the complete remission (CR) rate was about 60%; by the end of the first year, this ratio did not change substantially. Complete fistula closure was achieved in 26 cases (38.3%) and 53 patients (51.5%) showed a partial response during the 1-year period. Regarding both perianal and luminal activities, CR rate was achieved in 23 cases (33.8%). However, after the biological therapy was discontinued, recurrence of fistulas could be detected in every second patient. Additional surgical intervention was performed in 45% of patients during the 1-year period (seton drainage of fistulas and abscess drainage). Conclusion. The anti- TNF-alpha therapy combined with surgery is an effective treatment of PCD. Approximately every third patient revealed complete fistula closure, while half of the other cases showed a partial response. Due to the high rate of fistula recurrence after stopping the biological therapy, more than 1 year of anti-TNF-α treatment may be beneficial.

Original languageEnglish
Pages (from-to)182-187
Number of pages6
JournalScandinavian Journal of Gastroenterology
Volume50
Issue number2
DOIs
Publication statusPublished - Feb 1 2015

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Crohn Disease
Fistula
Tumor Necrosis Factor-alpha
Biological Therapy
Therapeutics
Drainage
Recurrence
Abscess
Compliance
Medical Records
Hypersensitivity

Keywords

  • Adalimumab
  • Biological therapy
  • Infliximab
  • Perianal Crohn's disease

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)

Cite this

Efficacy of combined anti-TNF-alpha and surgical therapy in perianal and enterocutaneous fistulizing Crohn's disease - Clinical observations from a tertiary Eastern European center. / Bor, Renáta; Farkas, Klaudia; Bálint, Anita; Szucs, Mónika; Ábrahám, Szabolcs; Baradnay, Gellért; Wittmann, T.; Szepes, Zoltán; Nagy, F.; Molnár, T.

In: Scandinavian Journal of Gastroenterology, Vol. 50, No. 2, 01.02.2015, p. 182-187.

Research output: Contribution to journalArticle

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abstract = "Background and aims. Recently, anti-TNF-alpha therapy has increasingly been used in the treatment of perianal Crohn's disease (PCD), but there is only limited data regarding its short- and long-term efficacy. Material and methods. The medical records of 68 patients treated with anti-TNF-alpha for PCD were assessed retrospectively. Rate of complex fistulas was 75{\%}. Every patient received induction therapy, but in 20 cases the treatment was discontinued before week 52 due to funding regulations, an allergic reaction, or compliance problems. On week 12, the luminal activity decreased in more than 80{\%} of the cases and the complete remission (CR) rate was about 60{\%}; by the end of the first year, this ratio did not change substantially. Complete fistula closure was achieved in 26 cases (38.3{\%}) and 53 patients (51.5{\%}) showed a partial response during the 1-year period. Regarding both perianal and luminal activities, CR rate was achieved in 23 cases (33.8{\%}). However, after the biological therapy was discontinued, recurrence of fistulas could be detected in every second patient. Additional surgical intervention was performed in 45{\%} of patients during the 1-year period (seton drainage of fistulas and abscess drainage). Conclusion. The anti- TNF-alpha therapy combined with surgery is an effective treatment of PCD. Approximately every third patient revealed complete fistula closure, while half of the other cases showed a partial response. Due to the high rate of fistula recurrence after stopping the biological therapy, more than 1 year of anti-TNF-α treatment may be beneficial.",
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AU - Bálint, Anita

AU - Szucs, Mónika

AU - Ábrahám, Szabolcs

AU - Baradnay, Gellért

AU - Wittmann, T.

AU - Szepes, Zoltán

AU - Nagy, F.

AU - Molnár, T.

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