Anthia Gatopoulou

AR Evenson

BE Sands

D Garcia-Olmo

DA Schwartz

Eleni I Efremidou

F Hadziselimovic

George Kouklakis

J Hinojosa

JF Colombel

JL Martinez

Konstantinos J Manolas

Konstantinos Simopoulos

L Peyrin-Biroulet

Nikolaos Liratzopoulos

P Hollington

Peter Zezos

RG Visschers

SB Hanauer

T Taner

Vassilios D Souftas

WJ Sandborn

Journal of Medical Case Reports

English

PubMed

Springer - Publisher Connector

Adalimumab - an effective and promising treatment for patients with fistulizing Crohn's disease: a case series

Abstract
          
            Introduction
            Crohn's disease is a chronic inflammatory bowel disease of unknown etiology which may affect any part of the bowel. Fistulas are a common and often serious complication of Crohn's disease. The treatment for fistulizing Crohn's disease can be medical, surgical or a combination of the two. Recently, adalimumab, a fully human anti-tumor necrosis factor monoclonal antibody, has been suggested as a safe and effective treatment for the induction and maintenance of remission in adult patients with moderate to severe Crohn's disease, who are refractory to conventional therapy or intolerant to infliximab. However, large studies focusing on evaluating the efficacy of adalimumab in fistulizing Crohn's disease have not yet been published.
          
          
            Case presentation
            We report the cases of three patients, of European Caucasian ethnicity and Greek nationality, with active luminal and fistulizing Crohn's disease. All of the cases were treated successfully with adalimumab. Patient 1 (a 44-year-old man) and patient 2 (an 18-year-old woman) developed early post-surgical enterocutaneous fistulas, while patient 3 (a 20-year-old woman) had peri-anal fistulizing Crohn's disease. Adalimumab treatment (160 mg subcutaneously at week zero, 80 mg at week two, and 40 mg every other week) was used for three different indications: (1) after the failure of other conservative medical treatments for Crohn's disease (patient 1); (2) as a monotherapy in treating a naive patient (patient 2); (3) after an intolerance to infliximab (patient 3). A remission of the active luminal and fistulizing disease was achieved soon after the initiation of adalimumab and sustained thereafter with maintenance doses. No further surgical intervention was required and no adverse effects were observed in any of the cases.
          
          
            Conclusions
            Fistulizing Crohn's disease remains a challenge in clinical practice. Adalimumab seems to be an effective, well-tolerated and safe treatment option for the induction and maintenance of remission in patients with moderate to severe peri-anal fistulizing Crohn's disease. Furthermore, adalimumab seems to be a promising treatment option for patients with moderate to severe fistulizing Crohn's disease with enterocutaneous fistulas. However, this clinical observation needs to be investigated in further clinical trials.
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Crossref

Adalimumab induces and maintains remission in severe, resistant paediatric Crohn disease.

BG: Surgical treatment of complex enterocutaneous fistulas in IBD patients using human acellular dermal matrix. Inflamm Bowel Dis

Colombel JF: Efficacy and safety of tumor necrosis factor antagonists in crohn’s disease: meta-analysis of placebo-controlled trials. Clin Gastroenterol Hepatol

F: Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes. World J Surg

Fischer JE: Current management of enterocutaneous fistula.

Gemert WG: Treatment strategies in 135 consecutive patients with enterocutaneous fistulas. World J Surg

Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology

PF: Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology

PF: Adalimumab for maintenance treatment of Crohn’s disease: results of the CLASSIC II trial. Gut

PF: Adalimumab for the treatment of fistulas in patients with Crohn’s disease. Gut

Sandborn WJ: The natural history of fistulizing Crohn’s disease in Olmsted County,

SJ: Infliximab maintenance therapy for fistulizing Crohn’s disease.

Treatment of enterocutaneous fistula in Crohn’s Disease with adipose-derived stem cells: a comparison of protocols with and without cell expansion.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3071343

Adalimumab - an effective and promising treatment for patients with fistulizing Crohn's disease: a case series

Abstract

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