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Use of Infliximab Does Not Reduce Rate of Fistulas in Patients With Crohn's Disease: Presented at ACS

By Roberta Friedman, PhD

SAN FRANCISCO -- October 17, 2008 -- Use of the anti-tumour necrosis factor-alpha inhibitor infliximab in Crohn's disease has not avoided the rectovaginal fistulas seen in that condition although its use may speed healing, according to results of a retrospective chart review presented here at the American College of Surgeons (ACS) 94th Annual Clinical Congress.

Wolfgang Bernd Gaertner, MD, Division of Colon and Rectal Surgery, University of Minneapolis, Minnesota, discussed the results in a presentation on October 15.

The chart review included 51 consecutive patients, with a mean age of 39 years, who had received different treatments for their fistulas: primarily seton drain (32 patients) as well as fibrin glue, transperineal repair, collagen plug, or Martius flap. Duration of perianal disease was 3 to 4 years. Patients were treated from 1998 to 2004. Infliximab use began in 2001.

Twenty-five patients received infliximab at 5 mg/kg for a minimum of 3 infusions. At a mean follow-up of 16 months, 26 fistulas had healed and 22 recurred. Diverted fistulas healed more often than those not diverted (80% vs 47%). Twelve patients eventually needed proctectomy.

Infliximab did not significantly change the incidence of healing, but did speed the time to healing from 8.1 months without infliximab to 2.9 months with infliximab, which was a statistically significant difference, Dr. Gaertner said.

Dr. Gaertner concluded that rectovaginal fistulas are difficult to treat and said that foecal diversion with the seton drain improves healing.

"Patients with the seton drain are not completely healed but do well and like to keep it in," Dr. Gaertner said. "This will skew the data on patients not taking infliximab."

Faecal diversion did not change the outcome of healing, he added.

[Presentation title: Results of Combined Medical and Surgical Treatment of Rectovaginal Fistulas in Crohn's Disease.]

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