TY - JOUR
T1 - Traitement par anticorps anti-tnf α (infliximab, remicade®) des lésions anopérinéales de la maladie de Crohn
AU - Ouraghi, Atika
AU - Nieuviarts, Sandrine
AU - Mougenel, Jean Luc
AU - Allez, Mathieu
AU - Barthet, Marc
AU - Carbonnel, Franck
AU - Cosnes, Jacques
AU - Gendre, Jean Pierre
AU - Flourié, Bernard
AU - Meurisse, Jean Jacques
AU - Quandalle, Pierre
AU - Ernst, Olivier
AU - Lemann, Marc
AU - Cortot, Antoine
AU - Modigliani, Robert
AU - Colombel, Jean Frédéric
PY - 2001
Y1 - 2001
N2 - Infliximab (Remicade®) has been shown to be an efficacious treatment for fistulae in patients with Crohn's disease, but its long term efficacy remains uncertain. Aim of the study - To retrospectively evaluate the efficacy, the duration of response, and the tolerance of Remicade® in anoperineal Crohn's disease. Methods - Fifty patients with severe symptomatic and refractory anoperineal Crohn's lesions (38 fistulae and 29 cavitating ulcers and superficial fissures) were treated with 3 intravenous infusions of Remicade® (5 mg/kg) at weeks 0, 2 and 6. Efficacy was assessed using Allan's functional score and proctologic examination at 8 weeks (W8) and 24 weeks (W24) after the first infusion. Results - At W8, a response was noted for 71% (27/38) of fistulae and 79% (23/29) of ulcers and fissures. Healing rates were 39% and 49%, respectively. Efficacy of Remicade® at W8 did not vary according to sex, number and type of fistulae and other treatments. At W24, 58% (15/26) of patients with fistulae and 63% (10/16) of patients with ulcers or fissures had a response. The response rate at W24 was higher in patients having anoperineal Crohn's lesions for less than one year: 77% vs 32% (P = 0.004). Median Allan's score significantly decreased from 3. 9 before treatment to 1.7 at W2 (P > 0.001), 1.3 at W6 and 0.8 at W8. Median duration of response was 9.5 months (range: 0.5-12.5) after last infusion and was not influenced by associated treatments including immunomodulators. The relapse rate at 1 year was 64% for the responders followed at least one year (n = 21). Minor adverse events occurred during 12% of all infusions. Eight patients had an infection, including one pneumonia. Eight patients developed a perineal abcess 16 weeks (range: 4-32) after the first infusion. Conclusion - Remicade® is rapidly effective and well tolerated in anoperineal Crohn's lesions, but the high relapse rate stresses the need for long term therapeutic strategies in these patients.
AB - Infliximab (Remicade®) has been shown to be an efficacious treatment for fistulae in patients with Crohn's disease, but its long term efficacy remains uncertain. Aim of the study - To retrospectively evaluate the efficacy, the duration of response, and the tolerance of Remicade® in anoperineal Crohn's disease. Methods - Fifty patients with severe symptomatic and refractory anoperineal Crohn's lesions (38 fistulae and 29 cavitating ulcers and superficial fissures) were treated with 3 intravenous infusions of Remicade® (5 mg/kg) at weeks 0, 2 and 6. Efficacy was assessed using Allan's functional score and proctologic examination at 8 weeks (W8) and 24 weeks (W24) after the first infusion. Results - At W8, a response was noted for 71% (27/38) of fistulae and 79% (23/29) of ulcers and fissures. Healing rates were 39% and 49%, respectively. Efficacy of Remicade® at W8 did not vary according to sex, number and type of fistulae and other treatments. At W24, 58% (15/26) of patients with fistulae and 63% (10/16) of patients with ulcers or fissures had a response. The response rate at W24 was higher in patients having anoperineal Crohn's lesions for less than one year: 77% vs 32% (P = 0.004). Median Allan's score significantly decreased from 3. 9 before treatment to 1.7 at W2 (P > 0.001), 1.3 at W6 and 0.8 at W8. Median duration of response was 9.5 months (range: 0.5-12.5) after last infusion and was not influenced by associated treatments including immunomodulators. The relapse rate at 1 year was 64% for the responders followed at least one year (n = 21). Minor adverse events occurred during 12% of all infusions. Eight patients had an infection, including one pneumonia. Eight patients developed a perineal abcess 16 weeks (range: 4-32) after the first infusion. Conclusion - Remicade® is rapidly effective and well tolerated in anoperineal Crohn's lesions, but the high relapse rate stresses the need for long term therapeutic strategies in these patients.
KW - Anoperineal lesions
KW - Crohn's disease
KW - Infliximab
UR - http://www.scopus.com/inward/record.url?scp=19244377957&partnerID=8YFLogxK
M3 - Article
C2 - 11845044
AN - SCOPUS:19244377957
SN - 0399-8320
VL - 25
SP - 949
EP - 956
JO - Gastroenterologie Clinique et Biologique
JF - Gastroenterologie Clinique et Biologique
IS - 11
ER -