Parsi Mansour A, Lashner Bret A, Achkar Jean-Paul, Connor Jason T, Brzezinski Aaron
Center for Inflammatory Bowel Disease, Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Am J Gastroenterol. 2004 Mar;99(3):445-9. doi: 10.1111/j.1572-0241.2004.04083.x.
Infliximab has been shown to be efficacious for treating perianal fistulae in patients with Crohn's disease. There is limited information regarding response to infliximab in patients with other types of fistulae.
Sixty consecutive patients with fistulous Crohn's disease and at least three months of follow-up after three infliximab infusions were evaluated. Patients with enteroenteric fistulae were excluded. Complete response was defined as complete closure of the fistulae or complete cessation of fistula drainage.
Thirty-five patients had external fistulae, 16 had internal fistulae, and 9 had mixed (both external and internal) fistulae. Complete response rates were significantly higher in patients with external fistulae (69%) compared to those with internal fistulae (13%); p= 0.001, or those with mixed fistulae (11%); p= 0.01. In the external fistula group, patients with perianal fistulae had a higher rate of complete response (78%) compared to those with abdominal wall fistulae (38%); p= 0.04. The rate of complete response to infliximab was significantly lower among 14 patients with rectovaginal fistulae (14%) compared to those with perianal fistulae (78%); p= 0.0007. In the mixed fistula group only 11% of the patients achieved complete response. This is significantly lower than the rate observed for patients with perianal fistulae (78%); p= 0.004. The Cox proportional hazards model showed that the hazard of relapse for smokers who achieved complete response was nearly twice that of nonsmokers; however, this difference did not reach statistical significance.
There is an association between type of fistulae and complete response to infliximab in patients with fistulous Crohn's disease. External fistulae in general and perianal fistulae in particular have a higher rate of closure in response to infliximab compared to other types of fistulae.
英夫利昔单抗已被证明对治疗克罗恩病患者的肛周瘘有效。关于其他类型瘘患者对英夫利昔单抗反应的信息有限。
对连续60例患有瘘管性克罗恩病且在接受三次英夫利昔单抗输注后至少随访三个月的患者进行评估。排除肠-肠瘘患者。完全缓解定义为瘘管完全闭合或瘘管引流完全停止。
35例患者有外瘘，16例有内瘘，9例有混合（外瘘和内瘘）瘘。外瘘患者的完全缓解率（69%）显著高于内瘘患者（13%）；p = 0.001，也高于混合瘘患者（11%）；p = 0.01。在外瘘组中，肛周瘘患者的完全缓解率（78%）高于腹壁瘘患者（38%）；p = 0.04。与肛周瘘患者（78%）相比，14例直肠阴道瘘患者对英夫利昔单抗的完全缓解率（14%）显著较低；p = 0.0007。在混合瘘组中，只有11%的患者实现了完全缓解。这显著低于肛周瘘患者的观察率（78%）；p = 0.004。Cox比例风险模型显示，实现完全缓解的吸烟者复发风险几乎是非吸烟者的两倍；然而，这种差异未达到统计学意义。
瘘管性克罗恩病患者的瘘管类型与对英夫利昔单抗的完全缓解之间存在关联。与其他类型的瘘相比，一般外瘘尤其是肛周瘘对英夫利昔单抗的闭合率更高。
