Long-term outcome of enterocutaneous fistula in patients with Crohn's disease treated with anti-TNF therapy: a cohort study from the GETAID.

Abstract

OBJECTIVES:

Although anti-tumor necrosis factor (TNF) therapy is the treatment of choice for perianal fistulizing Crohn's disease (CD), the efficacy and safety of anti-TNF therapy in enterocutaneous fistula (ECF) remains unclear.

METHODS:

Between January 2008 and December 2009, we retrospectively reviewed the outcomes of all CD patients with ECF (excluding perianal fistula) treated with anti-TNF therapy followed up in Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID) centers. ECF closure and tolerance of anti-TNF therapy were studied using univariate and multivariate analyses.

RESULTS:

Forty-eight patients (twenty-six women; median age 34.6 (interquartile range=25.0-45.5) years) were included in this study. The median follow-up period was 3.0 (2.0-6.6) years. The fistula was located in the small bowel (n=38), duodenum (n=1), and colon (n=9). The fistula has been developed in ileocolonic anastomosis in 17 (35%) cases. Sixteen patients (33%) had complex fistulas with multiple tracts and eleven patients (23%) had a high ECF output (if wearing an ostomy bag). Complete ECF closure was achieved in 16 (33%) patients, of whom eight relapsed during the follow-up period. In multivariate analysis, complete ECF closure was associated with the absence of multiple ECF tracts and associated stenosis. An abdominal abscess developed in 15 (31%) patients. ECF resection was needed in 26 (54%) patients. One patient died after surgery owing to abdominal sepsis.

CONCLUSIONS:

In CD patients with ECF, anti-TNF therapy may be effective in up to one-third of patients, especially in the absence of stenosis and complex fistula. A careful selection of patients is mandatory to prevent treatment failure and improves the safety.

• Authors: Aurelien Amiot, Vida Setakhr, Philippe Seksik, Mathieu Allez, Xavier Treton, Martine De Vos, David Laharie, Jean-Frederic Colombel, Vered Abitbol, Jean Marie Reimund, Jacques Moreau, Michel Veyrac, Bernard Flourié, Jacques Cosnes, Marc Lemann, Yoram Bouhnik
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 109 Issue 9 Pg. 1443-9 (Sep 2014) ISSN: 1572-0241 [Electronic] United States
• PMID: 25091063 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab

Topics

• Adalimumab
• Adult
• Anastomosis, Surgical (adverse effects)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, therapeutic use)
• Antibodies, Monoclonal (administration & dosage, therapeutic use)
• Antibodies, Monoclonal, Humanized (administration & dosage, therapeutic use)
• Colon (surgery)
• Colonic Diseases (drug therapy, etiology, surgery)
• Crohn Disease (complications, drug therapy, surgery)
• Cutaneous Fistula (drug therapy, etiology, surgery)
• Duodenal Diseases (drug therapy, etiology, surgery)
• Female
• Follow-Up Studies
• Humans
• Ileum (surgery)
• Infliximab
• Intestinal Fistula (drug therapy, etiology, surgery)
• Intestine, Small
• Male
• Middle Aged
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Young Adult