Long-term outcome of non-fistulizing (ulcers, stricture) perianal Crohn's disease in patients treated with infliximab

G Bouguen, I Trouilloud, L Siproudhis, A Oussalah, M-A Bigard, J-F Bretagne, L Peyrin-Biroulet
Alimentary Pharmacology & Therapeutics 2009, 30 (7): 749-56

BACKGROUND: In Crohn's disease, anal ulcers and stricture can be disabling.

AIM: To evaluate long-term outcome of non-fistulizing perianal Crohn's disease under infliximab.

METHODS: The medical records of 99 patients with non-fistulizing perianal Crohn's disease at first infliximab infusion were reviewed. Complete responses (ulcer healing or stricture regression) after induction infliximab therapy and at the maximal follow-up were assessed.

RESULTS: Ninety-four patients (94.9%) had ulcers, 22 (22.2%) had stricture and 31 (31.3%) had draining perianal fistulas at first infliximab infusion. After infliximab induction therapy, 40/94 (42.5%) patients with ulcers, 4/22 (18.2%) with stricture and 10/31 (32.2%) with fistulas had a complete response. Eight patients were lost to follow-up. After a median follow-up of 175 weeks (range, 13-459), complete response rates for ulcers, stricture and fistulas were 72.3% (68/94), 54.5% (12/22) and 54.8% (20/31) respectively. Long-term response for cavitating ulcer was positively associated with concomitant immunosuppressant use (P = 0.017) and older age (P = 0.049). Among the 12 patients with complete regression of stricture, 6 patients also had anal dilatation. Complete response was associated with perianal pain relief and disappearance of soiling. Three patients with ulcers developed an anal abscess.

CONCLUSIONS: Infliximab therapy may be effective in inducing and maintaining response for ulcers.

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