Clinical efficacy of adalimumab versus infliximab and the factors associated with recurrence or aggravation during treatment of anal fistulas in Crohn`s disease = Clinical efficacy of adalimumab versus infliximab and the factors associated with recurrence or aggravation during treatment of anal fistulas in Crohn`s disease

다국어 초록 (Multilingual Abstract)

Background/Aims: Infliximab has proven to be effective in the treatment of perianal fistulas in Crohn`s disease (CD) but the efficacy of adalimumab is still unclear. The aim of this study is to assess the clinical efficacy of adalimumab and compare the results with those for infliximab. Methods: Forty-seven CD patients treated for perianal fistulas with infliximab from September 2005 to December 2010 (n=31), or with adalimumab from November 2010 to May 2012 (n=16), were enrolled in this retrospective study. The following patient characteristics were analyzed; intestinal lesion site, fistula classification, seton placement, index of inflammatory bowel disease, C-reactive protein level, follow-up period, and the cumulative rate of nonrecurrence or aggravation of fistula. Results: There were no significant differences in the intestinal lesion site, fistula classification, inflammatory bowel disease index, C-reactive protein level, and the frequency of injection between the infliximab group and the adalimumab group. The cumulative rate of nonrecurrence or aggravation of fistula was 62.5% in the adalimumab group and 83.9% in the infliximab group at 24 months after treatment (P =0.09). The risk factors for recurrence or aggravation may be related to seton placement (P =0.02), gender (P =0.06), and fistula classification (P =0.07). Conclusions: There was no significant difference in the clinical efficacy of adalimumab and infliximab in the treatment of perianal fistulas in CD. However, fistula classification may be an important risk factor for recurrence or aggravation. The preliminary findings in this study show that further research is warranted. (Intest Res 2017;15:182-186)

참고문헌 (Reference)

1 Kawalec P, "Tumor necrosis factor-alpha antibodies (infliximab, adalimumab and certolizumab)in Crohn’s disease: systematic review and meta-analysis" 9 : 765-779, 2013

2 Hukkinen M, "Treatment of complex perianal fistulas with seton and infliximab in adolescents with Crohn’s disease" 8 : 756-762, 2014

3 Kappelman MD, "The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States" 5 : 1424-1429, 2007

4 Penner A, "Perianal fistulae as a complication of regional ileitis" 108 : 867-873, 1938

5 Marzo M, "Management of perianal fistulas in Crohn’s disease: an up-to-date review" 21 : 1394-1403, 2015

6 Sands BE, "Maintenance infliximab does not result in increased abscess development in fistulizing Crohn’s disease: results from the ACCENT II study" 23 : 1127-1136, 2006

7 Tozer P, "Long-term MRI-guided combined anti-TNF-alpha and thiopurine therapy for Crohn’s perianal fistulas" 18 : 1825-1834, 2012

8 Su CG, "Influence of immunogenicity on the long-term efficacy of infliximab in Crohn’s disease" 125 : 1544-1546, 2003

9 Ng SC, "Incidence and phenotype of inflammatory bowel disease based on results from the Asia-Pacific Crohn’s and colitis epidemiology study" 145 : 158.e2-165.e2, 2013

10 Zeng Z, "Incidence and clinical characteristics of inflammatory bowel disease in a developed region of Guangdong Province, China: a prospective population-based study" 28 : 1148-1153, 2013

11 Ueno F, "Evidence-based clinical practice guidelines for Crohn’s disease, integrated with formal consensus of experts in Japan" 48 : 31-72, 2013

12 Echarri A, "Evaluation of adalimumab therapy in multidisciplinary strategy for perianal Crohn’s disease patients with infliximab failure" 4 : 654-660, 2010

13 Castaño-Milla C, "Effectiveness of adalimumab in perianal fistulas in Crohn’s disease patients naive to anti-TNF therapy" 49 : 34-40, 2015

14 Yao T, "Crohn’s disease in Japan: diagnostic criteria and epidemiology" 43 (43): S85-S93, 2000

15 Antakia R, "Combined modality treatment for complex fistulating perianal Crohn’s disease" 15 : 210-216, 2013