Infliximab therapy for Crohn's disease anoperineal lesions - 06/05/08
Atika Ouraghi* [1],
Sandrine Nieuviarts* [1],
Jean-Luc Mougenel [2],
Mathieu Allez [3],
Marc Barthet [4],
Franck Carbonnel [5],
Jacques Cosnes [5],
Jean-Pierre Gendre [5],
Bernard Flourié [6],
Jean-Jacques Meurisse [7],
Pierre Quandalle [8],
Olivier Ernst [9],
Marc Lemann [3],
Antoine Cortot [1],
Robert Modigliani [3],
Jean-Frédéric Colombel [1]
Voir les affiliationsInfliximab (Remicade®) has been shown to be an efficacious treatment for fistulae in patients with Crohn's disease, but its long term efficacy remains uncertain.
Aim of the study |
To retrospectively evaluate the efficacy, the duration of response, and the tolerance of Remicade® in anoperineal Crohn's disease.
Methods |
Fifty patients with severe symptomatic and refractory anoperineal Crohn's lesions (38 fistulae and 29 cavitating ulcers and superficial fissures) were treated with 3 intravenous infusions of Remicade® (5 mg/kg) at weeks 0, 2 and 6. Efficacy was assessed using Allan's functional score and proctologic examination at 8 weeks (W8) and 24 weeks (W24) after the first infusion.
Results |
At W8, a response was noted for 71% (27/38) of fistulae and 79% (23/29) of ulcers and fissures. Healing rates were 39% and 49%, respectively. Efficacy of Remicade® at W8 did not vary according to sex, number and type of fistulae and other treatments. At W24, 58% (15/26) of patients with fistulae and 63% (10/16) of patients with ulcers or fissures had a response. The response rate at W24 was higher in patients having anoperineal Crohn's lesions for less than one year: 77% vs 32% (P = 0.004). Median Allan's score significantly decreased from 3.9 before treatment to 1.7 at W2 (P < 0.001), 1.3 at W6 and 0.8 at W8. Median duration of response was 9.5 months (range: 0.5-12.5) after last infusion and was not influenced by associated treatments including immunomodulators. The relapse rate at 1 year was 64% for the responders followed at least one year (n = 21). Minor adverse events occurred during 12% of all infusions. Eight patients had an infection, including one pneumonia. Eight patients developed a perineal abcess 16 weeks (range: 4-32) after the first infusion.
Conclusion |
Remicade® is rapidly effective and well tolerated in anoperineal Crohn's lesions, but the high relapse rate stresses the need for long term therapeutic strategies in these patients.
Keywords:
Crohn's disease
,
Anoperineal lesions
,
Infliximab
Plan
© 2001 Elsevier Masson SAS. Tous droits réservés.
Vol 25 - N° 11
P. 949-956 - novembre 2001 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.