Anti-TNF treatment of complex perianal fistulas in children without luminal Crohn's disease: Is it an option?
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In brief
In brief
Retrospective study of 17 pediatric patients with complex perianal fistulas without luminal Crohn's disease treated with anti-TNF agents (infliximab or adalimumab). At median 30.7-month follow-up, 53% achieved clinical remission and 36% showed radiologic response, suggesting anti-TNF may be effective for isolated perianal disease in children.
Written by the GCMD Library team from the article.
Objectives
Complex perianal fistulas (CPFs) in children even in the absence of luminal symptoms prompt evaluation for Crohn's disease (CD). Reports of isolated CPF in children, however, are sparse. In perianal CD, anti-tumor necrosis factor-α (anti-TNF) therapy is recommended. We aimed to describe our experience with anti-TNF therapy in children with isolated CPF without evidence of luminal CD.
Methods
We retrospectively reviewed charts of patients with isolated CPF who were treated with anti-TNF agents between 2011 and 2019 in a tertiary center. MRI pelvis findings at baseline versus end of follow-up were scored using MAGNIFI-CD. Outcomes included clinical remission, radiological response and radiological remission based on MAGNIFI-CD score at end of follow-up.
Results
Overall, 17 patients were identified, [10 males (59%), mean age at anti-TNF initiation 13.4±2.9 years]. Median time from perianal disease onset to anti-TNF was 16.5 months (IQR 9.4-36.4). None of the patients had luminal inflammation. Prior to anti-TNF, all patients had been treated with antibiotics without sufficient improvement, and 9/17 with abscess drainage and or seton insertion. Nine patients (53%) were treated with infliximab while 8 (47%) received adalimumab. Median duration of follow-up was 30.7 months (IQR=12.7-44.8). At the end of follow-up 9 patients (53%) achieved clinical remission. When comparing MRI prior to and after anti-TNF, 36% (5/14) had radiologic response, of whom 2 (14%) achieved radiologic resolution.
Conclusion
Anti-TNF agents may be an effective treatment option for children with isolated CPF. Whether these patients should be considered part of the CD phenotypic spectrum or a distinct entity is unclear.
Levels of Evidence
Therapeutic