Cyclosporin treatment of anal and perianal lesions associated with Crohn's disease.

BACKGROUND/AIMS: To analyse the long-term effect of cyclosporin on anal-perianal lesions associated with Crohn's disease.

METHODS

Twenty patients (15 females and 5 males); having Crohn's disease with anal-perianal involvement and resistant to conventional treatment were evaluated. The following criteria of diagnosis and evaluation were applied to all patients: onset of Crohn's disease, description of anal-perianal lesions according to Cardiff classification after proctological examination, onset of symptoms and their aggravation, and previous agents and surgical interventions. Cyclosporin was administered orally following intravenous treatment for 7 days (4 mg/kg/day). Dose adjustments' target was to achieve a cyclosporin level of 100/200 ng/mL. The efficacy of treatment was assessed by proctologists on days; 15 and 30, so-called acute period, and at 3, 6, 7, and 20 months, so-called chronic period. Patients were also seen between these two periods as needed, based on the condition of patients and their symptoms. At each examination, patients were scored according to Cardiff classification and the anatomical localisation of lesions, with the scores recorded subsequently.

RESULTS

Symptomatic improvements were seen in 80-85% of patients while proceeding from acute to chronic period. Oral treatment was continued for 3-7 months. In acute period (in the follow-up assessments: on days 15 and 30), 16/20 (80%) patients had symptomatic improvements, 5/20 (25%) had improvements in all anal-perianal lesions, 11/20 (55%) had regression of lesions, and 4/20 (20%) had worsening of lesions. In chronic period (range, 1-20 months; mean, 5 months), no complication occurred and no patient showed reactivation. In chronic period, the observation was that; 45% of fistulae were closed and 70% of ulcers healed. During treatment, 3 (15%) patients underwent a definitive ileostomy and 4 patients underwent surgical drainage of abscess of ano-vaginal and ano-perianal fistula.

CONCLUSIONS

In treatment of anal-perianal lesions associated with Crohn's disease, cyclosporin is an important agent in providing regression and healing of lesions in cases refractory to standard treatment. It should be considered an alternative treatment particularly in restorative surgical interventions. Comparisons are needed versus newer agents and cyclosporin for efficacy and superiority.