Crohn's disease is a chronic inflammatory bowel disease of unknown etiology which may affect any part of the bowel. Fistulas are a common and often serious complication of Crohn's disease. The treatment for fistulizing Crohn's disease can be medical, surgical or a combination of the two. Recently, adalimumab, a fully human anti-tumor necrosis factor monoclonal antibody, has been suggested as a safe and effective treatment for the induction and maintenance of remission in adult patients with moderate to severe Crohn's disease, who are refractory to conventional therapy or intolerant to infliximab. However, large studies focusing on evaluating the efficacy of adalimumab in fistulizing Crohn's disease have not yet been published. We report the cases of three patients, of European Caucasian ethnicity and Greek nationality, with active luminal and fistulizing Crohn's disease. All of the cases were treated successfully with adalimumab.
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Fistulas: What You Need to Know About a Common Side Effect of Crohn’s | Everyday Health
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A phase III, multicentre, randomised, double-blind, placebo controlled study with an open-label extension was conducted in 92 sites. At week 4, all patients were randomly assigned to receive double-blind placebo or adalimumab 40 mg every other week or weekly to week 56 irrespective of fistula status. Patients completing week 56 of therapy were then eligible to enroll in an open-label extension. Of patients enrolled, had draining fistulas at both screening and baseline 70 randomly assigned to adalimumab and 47 to placebo. The mean number of draining fistulas per day was significantly decreased in adalimumab-treated patients compared with placebo-treated patients during the double-blind treatment period.
Endoscopic Ultrasound (EUS) Guided Treatment With Humira for Crohn's Perianal Fistulas
Of importance, perianal disease is more commonly detected in East Asia, involving Treatment goals for perianal fistula are reduction of abscess drainage and symptoms, and ultimately resolution of fistula discharge, improvement in quality of life, with preservation of continence, fistula healing, and avoidance of proctectomy and a stoma. Simple asymptomatic perianal fistulas usually do not require treatment. For symptomatic simple perianal fistulas, antibiotics, most commonly metronidazole and ciprofloxacin, are considered first-line treatment. Although antibiotics improve fistula symptoms and may contribute to healing, they do not induce complete fistula closure, and the fistula often deteriorates after their discontinuation.
Abstract: Despite significant advances in the treatment of luminal inflammatory bowel disease, the treatment of perianal fistulas remains a clinical challenge. Perianal fistulas are traditionally described using the Parks classification based on their relationship to the external and internal anal sphincters. Traditional therapy for perianal fistulas focuses on antibiotics such as metronidazole or ciprofloxacin. However, medical management has expanded over the years to include immunomodulators and, most recently, biologic agents. Newer techniques such as intrafistulous biologic injections are also being explored as potentially effective treatments for patients with fistulizing disease.