PERIANAL COMPLETE REMISSION WITH COMBINED THERAPY (SETON PLACEMENT AND ANTI-TNF AGENTS) IN Crohn’s DISEASE: a Brazilian multicenter observational study

Remissão perianal completa com terapia combinada (sedenhos e agentes biológicos) na doença de Crohn: um estudo brasileiro observacional e multicêntrico

Background

Perianal fistulizing Crohn’s disease is one of the most severe phenotypes of inflammatory bowel diseases. Combined therapy with seton placement and anti-TNF therapy is the most common strategy for this condition

Objectives

The aim of this study was to analyze the rates of complete perianal remission after combined therapy for perianal fistulizing Crohn’s disease.

Methods

This was a retrospective observational study with perianal fistulizing Crohn’s disease patients submitted to combined therapy from four inflammatory bowel diseases referral centers. We analyzed patients’ demographic characteristics, Montreal classification, concomitant medication, classification of the fistulae, occurrence of perianal complete remission and recurrence after remission. Complete perianal remission was defined as absence of drainage from the fistulae associated with seton removal.

Discussion

A total of 78 patients were included, 44 (55.8%) females with a mean age of 33.8 (±15) years. Most patients were treated with Infliximab, 66.2%, than with Adalimumab, 33.8%. Complex fistulae were found in 52/78 patients (66.7%). After a medium follow-up of 48.2 months, 41/78 patients (52.6%) had complete perianal remission (95% CI: 43.5%-63.6%). Recurrence occurred in four (9.8%) patients (95% CI: 0.7%-18.8%) in an average period of 74.8 months.

Conclusions

Combined therapy lead to favorable and durable results in perianal fistulizing Crohn’s disease.

Crohn’s disease; Tumor necrosis factor-alpha; Rectal fistula.