Management of fistulas in patients with Crohn’s disease: INFLIXIMAB, THALIDOMIDE AND ANECDOTAL CASE REPORTS

14 Apr


INFLIXIMABInfliximab, a humanized chimeric monoclonal antibody to tumour necrosis factor-alpha, was recently assessed in a randomized, double-blind, placebo controlled study involving 94 patients with fistulas. After a median response time of two weeks, fistulas closed in 46% (29 of 63) and 13% (four of 31) of infliximab-treated and placebo-treated patients, respectively; improvement was also noted in 16% (10 of 63) and 13% (four of 31), respectively. Two doses of infliximab (5 and 10 mg/kg) were tested; the lower dose was associated with a higher response rate. There was a consistent treatment benefit regardless of concomitant therapy (eg, the presence or absence of therapy with AZA or 6-MP). However, the effect of treatment was not maintained; about 60% of patients with closed fistulas relapsed four months after the last infusion, and more than 90% relapsed 12 months after the last infusion. Overall, the median duration of response was three months. Infliximab was administered at zero, two and six weeks for the treatment of fistulas. A recent study showed that patients who failed to respond to the second infusion were unlikely to respond to the third infusion, suggesting that the last dose is not necessary to achieve the same results.


Two recent uncontrolled studies involving patients with Crohn’s disease suggested that only a few weeks’ treatment with thalidomide may result in closure or improvement of fistulas; better outcomes were observed at doses between 100 and 300 mg/day. Best quality drugs are waiting – buy yasmin online to spend less time and money.


Case reports have suggested a benefit of granulocyte colony-stimulating factor, oral tacrolimus and clofazimine in the treatment of fistulizing Crohn’s disease .