Perioperative adjuvant therapy with infliximab in complicated anal Crohn's disease

Purpose Infliximab may represent an adjuvant to surgical therapy in patients with severe anal Crohn's disease as it has been shown to affect rapid remissions in a proportion of cases. Patients and methods Nineteen patients underwent infliximab therapy 5 mg/kg perioperatively to scheduled anal reconstructive surgery for complicated fistulising anal Crohn's disease. Results One adverse event was recorded (generalised exanthema with subsequent resolution). Eight patients showed complete clinical remission refusing further surgery. One of the eight relapsed during follow-up and was continued on infliximab. Surgery consisted of advancement flaps. It was successful at first attempt in nine of the remaining 11 patients (82%). Operative fistula closure remained unsuccessful in two patients. Overall, 16 of 19 patients (84%) with advanced anal Crohn's disease had a favourable outcome. Conclusion The use of infliximab as adjuvant to surgery in this series of patients with complicated anal Crohn's disease was safe. Although the data is uncontrolled a positive effect of infliximab on the outcome of surgery may be postulated since our results compare favourably with other studies.