Management of fistulas in patients with Crohn’s disease: DRUGS USED TO TREAT

27 Jul
2012

DRUGS USED TO TREAT FISTULIZING CROHN’S DISEASEOverall (Table 1), metronidazole and cyclosporine have a high efficacy in closing or improving fistulas, with an onset of action of a few days to a few weeks. However, neither drug provides sustained healing of fistulas, and both are rather poorly tolerated. Thalidomide shows promise in inducing closure or improvement of fistulas within weeks, but the sustained response is not known, and the drug has a rather limited tolerability for chronic use. AZA or 6-MP, and infliximab are effective in the treatment of patients with fistulas and are well tolerated under their current use; the time to response is short (two weeks) with infliximab and prolonged (three months or more) with AZA and 6-MP. Fistulas frequently relapse after discontinuation of therapy with all drugs; AZA and 6-MP are the only drugs with an established long term safety profile. The long term safety profile of infliximab requires additional clinical investigation. Spend less money now – buy glucophage for your efficient drug to cost less.

TABLE 1
Drugs used for the treatment of fistulizing Crohn’s disease

DrugEfficacy (clos; global)Onset of actionRelapse after D/CLong term use and safety
Antibiotics(metro)Very high (44%;>90%)WeeksHigh Poorlytolerated
Cyclosporine (high dose) High(28%;>90%)DaysHigh Poorlytolerated
Thalidomine (100 to 300 mg/day) Mod high(46%;>70%)WeeksUnknown Limitedtolerability
AZA/6-MP Mod high(30%;60%)MonthsHigh Welltolerated
Infliximab Mod high(46%;60%)WeeksHighProbably well tolerated
MTX Mod high(25%;55%)High Limitedtolerability

AZA Azathioprine; Clos Closure; D/C Discontinuation; metro Metronidazole; Mod Moderately; 6-MP 6-Mercaptopurine; MTX Methotrexate

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