Optimized timing of using infliximab in perianal fistulizing Crohn's disease

Infliximab (IFX), as a drug of first-line therapy, can alter the natural progression of Crohn's disease (CD), promote mucosal healing and reduce complications, hospitalizations, and the incidence of surgery. Perianal fistulas are responsible for the refractoriness of CD and represent a more agg...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2020-04, Vol.26 (14), p.1554-1563
Main Authors: Sun, Xue-Liang, Chen, Shi-Yi, Tao, Shan-Shan, Qiao, Li-Chao, Chen, Hong-Jin, Yang, Bo-Lin
Format: Article
Language:English
Subjects:
Crohn Disease - complications
Crohn Disease - diagnosis
Crohn Disease - drug therapy
Drug Administration Schedule
Humans
Infliximab - administration & dosage
Magnetic Resonance Imaging
Opinion Review
Proctoscopy
Rectal Fistula - diagnosis
Rectal Fistula - drug therapy
Rectal Fistula - etiology
Recurrence
Remission Induction - methods
Secondary Prevention - methods
Time Factors
Treatment Outcome
Wound Healing - drug effects
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Summary:Infliximab (IFX), as a drug of first-line therapy, can alter the natural progression of Crohn's disease (CD), promote mucosal healing and reduce complications, hospitalizations, and the incidence of surgery. Perianal fistulas are responsible for the refractoriness of CD and represent a more aggressive disease. IFX has been demonstrated as the most effective drug for the treatment of perianal fistulizing CD. Unfortunately, a significant proportion of patients only partially respond to IFX, and optimization of the therapeutic strategy may increase clinical remission. There is a significant association between serum drug concentrations and the rates of fistula healing. Higher IFX levels during induction are associated with a complete fistula response in these patients. Given the apparent relapse of perianal fistulizing CD, maintenance therapy with IFX over a longer period seems to be more beneficial. It appears that patients without deep remission are at an increased risk of relapse after stopping anti-tumor necrosis factor agents. Thus, only patients in prolonged clinical remission should be considered for withdrawal of IFX treatment when biomarker and endoscopic remission is demonstrated, especially when the hyperintense signals of fistulas on T2-weighed images have disappeared on magnetic resonance imaging. Fundamentally, the optimal timing of IFX use is highly individualized and should be determined by a multidisciplinary team.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v26.i14.1554