Long-term outcome of perianal fistulizing Crohn's disease treated with infliximab

TLDR: Combination therapy, duration of seton drainage less than 34 weeks, and long-term treatment with infliximab were associated with better outcomes, and about two-thirds of patients with fistulizing perianal Crohn's disease had fistula closure, and one-third had fistulas recurrence after inflixIMab initiation.

About: This article is published in Clinical Gastroenterology and Hepatology.The article was published on 2013-08-01 and is currently open access. It has received 162 citations till now. The article focuses on the topics: Fistula & Infliximab.

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Table 2: Factors associated with first perianal fistula closure, as determined by multivariate analysis

Table 1: Baseline characteristics

Frequently asked questions

Q1. What have the authors contributed in "Long-term outcome of perianal fistulizing crohn’s disease treated with infliximab" ?

Bouguen et al. this paper evaluated the long-term outcome of perianal fistulizing Crohn 's disease treated with infliximab. 

Q2. What were the important factors associated with fistula closure?

Simple fistula, prior major abdominal surgery, absence of seton and short seton drainage duration were associated with an increased probabilities of achieving sustained fistula closure. 

Q3. What was the p value of the log-rank test?

To identify independent predictors of surgery using a multivariate analysis, all significant variables with p values of <0.05 in the log-rank test were retained in the model and integrated into a Cox proportional hazards regression model. 

Q4. How many patients were treated with IFX as maintenance therapy?

In the ACCENT II trial, 42% of randomized patients treated with IFX as maintenance therapy experienced loss of response, including 16% of patients with recrudescence of fistulas. 

Q5. What are the common symptoms of a dreaded manifestation of Crohn's?

Keywords: fistula, perianal disease, Crohn’s disease, infliximabPerianal fistulas are one of the more dreaded manifestations of Crohn's disease (CD). 

Q6. What are the predictors of fistula closure?

Predictors of fistula closure were ileocolonic disease (HR=1.88), concomitant immunosuppressants (HR=2.58), duration of seton drainage < 34 weeks (HR=2.31) and a long duration of infliximab treatment (HR=1.76). 

Q7. How long did present et al find that the fistulas were removed?

Present et al found that closure of draining fistulae by IFX treatment was characterized by rapid onset (usually within 2 weeks) and a lasting benefit of action, with a median duration of closure of 12 weeks. 

Q8. How many patients had a complete fistula closure?

Recurrence of fistula and abscessOf the 108 patients who experienced at least one complete fistula closure, 36 (33.3%, 95% CI 25- 42) had recurrence of fistula, including 24 patients with concomitant abscess. 

Q9. How many patients had complete closure of their fistulas?

72 (46%) of the 156 patients had sustained complete fistula closure throughout follow-up, including maximal follow-up. 

Q10. How many patients had a fistula before or after the diagnosis of CD?

In population-based studies, perianal or rectal fistulas occur either before or after the diagnosis of CD in 13.7% to 37% of cases. 

Q11. What was the effect of IFX discontinuation on the fistula?

IFX discontinuation and a long interval period over 6 weeks between the placement of seton and the start of IFX was negatively associated with sustained fistula closure. 

Q12. What is the limitation of the study?

A limitation of their study, in addition to its retrospective study design, is the absence of MRI data, as it was not routinely performed during study period. 

Q13. What were the main characteristics of the abscess recurrence?

When considering abscess recurrence, IFX discontinuation and a low number of infusions (under 19 using ROC curve analysis) were associated with recurrence in univariate analysis (See Supplementary Table 5 online). 

Q14. What was the time to heal or recurrence of abscess?

For fistula closure and recurrence of abscess, the time to healing or to recurrence was considered to begin atthe date of first IFX infusion and end at the date of complete fistula closure/recurrence of abscess or last known follow-up. 

Q15. How many IFX infusions did the patients receive?

Management of perianal lesions during follow-up (Figure 1) After a median duration follow-up of 250 weeks (IQR 124-381), a total of 2536 IFX infusions were administered to the 156 included patients, corresponding to a median number of IFX infusions per patient of 11.5 (IQR 5-23).