Perianal Crohn’s disease is carbon friendly

▸ Fukuda Y, Takazoe M, Sugita A, et al. Oral spherical adsorptive carbon for the treatment of intractable anal fistulas in Crohn’s disease: A multicenter randomized double-blind placebo-controlled trial. Am J Gastroenterol 2008;103:1721–9.

Perianal fistulas are a frustrating and potentially disabling complication of Crohn’s disease for which few treatments are available. AST-120, an oral spherical adsorptive carbon, has been used in Japan to treat renal disease, but was observed serendipitously to close fistulas in patients with concomitant Crohn’s disease. Accordingly, Fukuda et al randomised 62 patients with perianal fistulising Crohn’s disease to receive either AST-120 or placebo for 8 weeks in a double-blind trial. Improvement of fistulas (defined as a 50% reduction from baseline in the number of draining fistulas) was seen in 37.0% of subjects on AST-120 versus 10.0% of those on placebo (p  =  0.025). Rates of remission (defined as complete closure of all draining fistulas) were 29.6% on AST-120 versus 6.7% on placebo (p  =  0.035). AST-120 also led to significant improvements in both the Perianal Disease Activity Index (PDAI) and the Crohn’s Disease Activity Index (CDAI). Of note, AST-120 was well tolerated with no increase in adverse events over placebo. The mechanism …