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P421. Long term results of infliximab treatment of fistulas in patients with Crohn's disease in Arctic Norway

R. Heitmann, R. Goll, J.R. Florholmen, University of Tromsø, The Arctic University of Norway, Department of Clinical Medicine, Tromsø, Norway

Background

Fistulas are frequent and serious complications of Crohn's disease. Since 1999 treatment with infliximab (IFX) has proven to be an effective treatment, often combined with surgery.

Methods

A computer based search identified all patients with Crohn's related fistulas treated with IFX from January 1. 1999 to December 31. 2012. Clinical characteristics, disease demographics, management and outcome were recorded from first time presentation to end of follow-up. IFX was given as standard induction therapy until complete remission (closure or nonsecreting).

Results

A complete record was obtained in 48 patients (54% female). Mean duration of Crohn's disease was 8 years and patient age 32 years. Mean time with active fistula was 23 months, time in remission 54 months and total observation time 77 months. Time in remission as part of total observational time was 66%. Surgery was required in combination with IFX in 83% of patients, 31% had surgery before, and 52% after initiation of IFX. IFX with or without surgery induced complete remission in 83%, and 35% of those patients later relapsed. If any fistula related surgery was required after starting treatment with IFX, this was associated with later relapse after successful treatment (p = 0.049, OR 30.4). Predictors of early relapse were associated with a previous fistulating disease (p < 0.035, HR = 30.1) and long disease duration (p = 0.027, HR = 1.2). A chronic relapsing disease was found among 17% of patients, and was associated with lack of concomitant immunomodulatory treatment (p < 0.006, OR 604).

Conclusion

Infliximab in combination with surgery, is an effective treatment for Crohn's disease related fistulas. A history of previous fistulating disease and long disease duration were associated with early relapse, whereas concomitant immunomodulatory treatment apparently improved long term prognosis.