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DOI: 10.1016/j.jcol.2014.05.001
Comparison between infliximab and adalimumab in the treatment of perianal fistulas in Crohn's disease
Comparação entre Adalimumabe e Infliximabe no tratamento das fístulas perianais na Doença de Crohn
Abstract
Introduction The fistulizing form of Crohn's disease (CD) represents a great challenge regarding treatment, especially perianal fistulas, for its high prevalence.
Objective To assess factors related to the response to surgical treatment associated with anti-TNF inpatients with CD and perianal fistulas.
Method Retrospective study of patients with CD and perianal fistulas who used IFX or ADA in association with surgical treatment.
Results 30 patients with a mean age of 35 years were studied; 16 were treated with ADA (9 ADA + AZA) and 14 with IFX (10 IFX + AZA); ten of those treated with ADA responded, and of the six non-respondents, only one responded to IFX; eight responded to IFX, and among those non-respondents, no one showed response with ADA; among the respondents, there were 10 men and nine women; of those non-respondents, eight were men and 3 women; of those under 40 years, 16 responded compared with only three non-respondents; of those over 40 years, three responded versus eight non-respondents; as to the time elapsed between the onset of the disease and the beginning of anti-TNF, 14 (<2 years), one (2–5 years) and four (>5 years) responded, and five (<2 years), four (2–5 years) and two (>5 years) were non-respondents.
Conclusion There was no difference in response between the anti-TNF agents used; a better response was noted in those who used anti-TNF in combination with azathioprine, among women, in those under 40 years and in those treated within two years of the onset of the disease.
Resumo
Introdução A forma fistulizante da Doença de Crohn (DC) apresenta um grande desafio quanto ao seu tratamento, especialmente as fístulas perianais pela sua alta prevalência.
Objetivo Analisar os fatores relacionados à resposta ao tratamento cirúrgico associado ao anti-TNF de pacientes com fístulas perianais por DC.
Método Estudo retrospectivo de pacientes com fístulas perianais por DC que fizeram uso de IFX ou ADA associado ao tratamento cirúrgico.
Resultados Foram estudados 30 pacientes com média de idade de 35 anos; 16 foram tratados com ADA (9 ADA + AZA) e 14 com IFX (10 IFX + AZA); 10 dos tratados com ADA tiveram resposta; e dos seis que não responderam, apenas um teve resposta com IFX; oito tiveram resposta com IFX; e dos que não responderam, nenhum apresentou resposta com ADA; dos que responderam, 10 eram homens e nove mulheres; dos que não responderam, oito eram homens e três mulheres; daqueles com menos de 40 anos, 16 responderam contra apenas três que não responderam; dos com mais de 40 anos, três responderam contra oito que não responderam; quanto ao tempo decorrido entre o início da doença e o início do anti-TNF, 14 (<2 anos), um (2-5 anos) e quatro (>5 anos) responderam, e cinco (<2 anos), quatro (2-5 anos) e dois (>5 anos) não responderam.
Conclusão Não houve diferença de resposta entre os agentes anti-TNF utilizados; houve melhor resposta nos que utilizaram anti-TNF em associação com azatioprina, entre as mulheres, nos pacientes com menos de 40 anos e naqueles tratados com até dois anos do início da doença.
Publication History
Received: 25 February 2014
Accepted: 15 May 2014
Article published online:
17 February 2021
© 2014. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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