Combining infliximab and methotrexate in fistulizing Crohn's disease resistant or intolerant to azathioprine

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SUMMARYBackgroundCrohn's disease is complicated by fistulas in 20–40% of patients at some time during the course of their illness. Azathioprine has been reported to heal fistulas in 30–40% of cases. Long-lasting effects by the anti-tumour necrosis factor-α antibody infliximab most often require repeated infusions. Methotrexate has been shown to be an effective drug in maintaining remission in Crohn's disease.AimTo evaluate the combination of infliximab and methotrexate as therapy for fistulas in patients with Crohn's disease.MethodsTwelve consecutive patients (mean age, 29.5 years) with fistulizing Crohn's disease resistant or intolerant to azathioprine were followed prospectively. Patients received three infusions of infliximab (5 mg/kg) and long-term methotrexate (20 mg/week). Therapy success was defined as sustained closure of fistulas ≥ 6 months after fistula closure.ResultsIn four of the 12 patients, complete closure of fistulas that persisted for ≥ 6 months (median follow-up, 13.25 months) was observed. In three further patients, a partial response was noted. In five patients, persistent therapy success could not be achieved or therapy had to be stopped due to side-effects.ConclusionsA combination of infliximab with long-term methotrexate may be a promising concept in fistulizing Crohn's disease. Our data indicate the need for larger controlled trials.

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