Journal Article

Infliximab Maintenance Therapy for Fistulizing Crohn's Disease

Chey, William Y, van Deventer, Sander J, Bernstein, Charles N, Rutgeerts, Paul, Anderson, Frank H, Sands, Bruce E, Wolf, Douglas C, Kamm, Michael A, Blank, Marion A, Feagan, Brian G, Wild, Gary, Korzenik, Joshua R, Onken, Jane E, Rachmilewitz, Daniel, Lashner, Bret A, Marsters, Paul A, Fedorak, Richard N, Travers, Suzanne B

2004

Overview

Infliximab, a monoclonal antibody against tumor necrosis factor, reduces disease activity in patients with Crohn's disease. In this study of patients with fistulizing Crohn's disease who had a response to infliximab, continued infusions every 8 weeks were associated with a longer duration of response than were placebo infusions. After 54 weeks of treatment, 36 percent of patients in the infliximab group and 19 percent of those in the placebo group had no draining fistulas. Maintenance treatment reduced the likelihood of relapse. Fistulas occur in 17 to 43 percent of patients with Crohn's disease. 1 , 2 Perianal fistulas, the most common variant, decrease the quality of life and increase the likelihood of total colectomy. 3 Although widely used in the treatment of fistulas, antibiotics, immunomodulators, and dietary therapies have not been demonstrated to result in sustained closure of fistulas in Crohn's disease. 4 – 9 Surgical options are limited by the potential for compromise of anal continence. Surgical diversion of the fecal stream by a stoma often produces healing; however, many patients find a stoma to be undesirable, and the benefit of this approach is unlikely . . .

• Publisher: Massachusetts Medical Society
• Subject: Adult / Aged / Antibiotics / Antibodies, Monoclonal - adverse effects / Antibodies, Monoclonal - therapeutic use / Biological and medical sciences / Bowel disease / Clinical trials / Crohn Disease - complications / Crohn Disease - drug therapy / Cutaneous Fistula - drug therapy / Cutaneous Fistula - etiology / Double-Blind Method / Drug therapy / Drug Tolerance / Female / Gastroenterology. Liver. Pancreas. Abdomen / Gastrointestinal Agents - adverse effects / Gastrointestinal Agents - therapeutic use / General aspects / Humans / Infliximab / Infusions, Intravenous / Intestinal Fistula - drug therapy / Intestinal Fistula - etiology / Male / Medical sciences / Middle Aged / Ostomy / Other diseases. Semiology / Patients / Rectal Fistula - drug therapy / Rectal Fistula - etiology / Recurrence / Remission Induction / Stomach. Duodenum. Small intestine. Colon. Rectum. Anus / Treatment Outcome / Tumor Necrosis Factor-alpha - antagonists & inhibitors