Complex perianal fistulas in Crohn’s disease: An anti-TNF α based medico-surgical treatment with magnetic imaging assessment

Abstract

Abstract: Background: Anti-TNFα associated to seton drainage has a central role in the treatment of complex perineal Crohn’s fistulas (PAF). A precise treatment protocol is lacking.
Aims: to evaluate the results of this combined treatment and identify predictive factors of response.
Methods: It was a retrospective study which included all patients with complex PAF treated with Anti-TNFα.
Results: We included 49 patients, mean age of 31.6 years. 17 patients had an active rectal involvement. 35 patients had azathioprin. After the induction, 43 patients had a clinical response. Maintenance therapy was started in 45 cases. After a median of 19 months of Anti-TNFα, 24 patients had a clinical remission (with radiological remission in 20), 17 a partial clinical response, and 4 were in failure. After clinico-radiologic remission setons were removed in all patients, 46% of patients who stopped Anti-TNFα treatment after clinico-radiologic remission relapsed. Absence of rectal involvement and Clinical remission after induction were the independent predictive factors of achieving a clinical remission under maintenance therapy with Anti-TNFα (p=0.016) and clinico-radiological remission (p=0.028).
Conclusion: An Anti-TNFα based treatment combined with long term loose seton drainage have contributed to the high rates of both clinical and radiological responses in this study. Obtaining a “deep” clinico-radiological remission should be the target of the treatment. Stopping the Anti-TNFα should be avoided even after obtaining such response.