Infliximab and surgical treatment of complex anal Crohn's disease

Aim Perianal fistulae in Crohns disease are frequently complex, involve the anal sphincter complex and surgical treatment can be associated with poor healing of wounds and damage to the mechanism of continence. The aim of this study was to evaluate the efficacy and duration of response to infliximab in the long-term management of perianal fistulae in Crohns disease in routine clinical practice. Method A prospectively maintained database was used to identify patients with Crohns disease and complex anal fistulae who were treated with infliximab (primary treatment, three initial infusions followed by maintenance therapy). Patients who received infliximab for luminal disease or for enterocutaneous, peristomal or rectovaginal fistulae were excluded from this study. Results Fifty-two patients [25 male, median age 24 (range 1572) years] were treated with infliximab for perianal Crohns fistulae for a median of 66 (7124) months. Twenty-six of the patients underwent pre-infliximab MRI scans and 38 had an examination under anaesthetic (EUA) prior to commencement of treatment, 22 of whom had seton(s) inserted into their fistulae. Maintenance therapy was possible in 42 (81%) of 52 patients. Twenty-two (42.3%) patients had a complete response to treatment, 23 (44.2%) had a partial response and 7 (13.5%) had no response. Less than complete response to infliximab was associated with a greater risk of requiring surgical intervention (Fishers exact test, d.f. 1, P = 0.005). Conclusion The response rates of Crohns related complex perianal fistulae to infliximab are good. Complete response is associated with a reduced need for surgical intervention.