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Perianal Crohn's Disease (perianal + crohn's_disease)
Selected AbstractsTopical tacrolimus in the treatment of perianal Crohn's disease: Exploratory randomized controlled trialINFLAMMATORY BOWEL DISEASES, Issue 3 2007Ailsa L. Hart PhD Abstract Background The aim of this study is to evaluate the efficacy of topical tacrolimus in treating perianal Crohn's disease. Methods Nineteen patients, stratified into 7 with ulcerating, and 12 with fistulizing, perianal Crohn's disease were randomized to topical tacrolimus 1 mg/g (1 g ointment twice a day [bid]) or placebo for 12 weeks. Sixteen patients had been on, or were currently taking, azathioprine/6-MP, and 6 had received infliximab. The primary outcome in ulcerating disease was global improvement in perianal/anal lesions, as assessed by the attending physician; for fistulas, it was reduction of ,50% of actively draining fistulas on 2 consecutive visits. Blood tacrolimus levels and adverse events were assessed. Results Three of 4 patients treated with topical tacrolimus for ulcerating disease improved compared with none of 3 in the placebo group. Complete healing was not achieved. In fistulizing disease, topical tacrolimus was not beneficial. Two tacrolimus-treated patients developed perianal abscesses, 1 after improvement in fistula drainage. Adverse events were otherwise infrequent and mild. Whole blood tacrolimus levels were detectable in only 2 patients and were low. Conclusions These preliminary data suggest that topical tacrolimus is effective and safe in the treatment of perianal or anal ulcerating Crohn's disease. This therapy is unlikely to be beneficial in fistulizing perianal Crohn's disease, although a larger study is required to confirm this. (Inflamm Bowel Dis 2006) [source] Long-term outcome of non-fistulizing (ulcers, stricture) perianal Crohn's disease in patients treated with infliximabALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009G. BOUGUEN Summary Background, In Crohn's disease, anal ulcers and stricture can be disabling. Aim, To evaluate long-term outcome of non-fistulizing perianal Crohn's disease under infliximab. Methods, The medical records of 99 patients with non-fistulizing perianal Crohn's disease at first infliximab infusion were reviewed. Complete responses (ulcer healing or stricture regression) after induction infliximab therapy and at the maximal follow-up were assessed. Results, Ninety-four patients (94.9%) had ulcers, 22 (22.2%) had stricture and 31 (31.3%) had draining perianal fistulas at first infliximab infusion. After infliximab induction therapy, 40/94 (42.5%) patients with ulcers, 4/22 (18.2%) with stricture and 10/31 (32.2%) with fistulas had a complete response. Eight patients were lost to follow-up. After a median follow-up of 175 weeks (range, 13,459), complete response rates for ulcers, stricture and fistulas were 72.3% (68/94), 54.5% (12/22) and 54.8% (20/31) respectively. Long-term response for cavitating ulcer was positively associated with concomitant immunosuppressant use (P = 0.017) and older age (P = 0.049). Among the 12 patients with complete regression of stricture, 6 patients also had anal dilatation. Complete response was associated with perianal pain relief and disappearance of soiling. Three patients with ulcers developed an anal abscess. Conclusions, Infliximab therapy may be effective in inducing and maintaining response for ulcers. [source] Infliximab in the surgical management of complex fistulating anal Crohn's diseaseCOLORECTAL DISEASE, Issue 2 2005C. Talbot Abstract Objectives To assess prospectively the efficacy and safety of treatment of perianal Crohn's disease by means of a combination of surgical management and a standardized protocol for the intravenous infusion of infliximab. Methods A consecutive series of patients who presented with complex perianal Crohn's fistulae between November 1999 and March 2003 were included in the study. Perianal sepsis was eradicated with drainage of collections and insertion of setons. Infliximab was infused at 5 mg/kg at 0, 2, and 6 weeks. Setons were removed after the second infliximab infusion. Endpoints were defined as either complete, partial or no response as noted at subsequent outpatient follow up. Adverse reactions were recorded. Results Twenty-one patients had a median of three fistulae per patient (range 1,9). All patients tolerated the initial protocol, receiving a median of five infusions of infliximab (range 3,19); median follow up 20 months (range 12,52). Eleven patients (53%) were continued on maintenance therapy with 12 weekly infusions of infliximab for either a perceived clinical need for treatment or after a relapse of their symptoms. Ten (47%) patients experienced a complete response to treatment and the remaining 11 (53%) experienced a partial response. No patient failed to respond to treatment. Four adverse reactions were noted (2 mild allergies, 1 rash and 1 patient experienced joint pains). All adverse reactions settled with cessation of the drug infusion. Conclusions The combination of seton drainage and infusion of infliximab completely healed the perineum of 47% patients with complex fistulating perianal Crohn's disease. Partial response was seen in the remainder of patients. No serious adverse reactions reported. [source] | ||||||||||