Introduction Crohn's disease affects 50–100 patients per 100 000 in the population and typically follows a progressive course, with fistulae occurring in 17% to 43% of patients. The most common type of fistulae, perianal, have been shown to decrease quality of life and increase the likelihood of total colectomy. This retrospective study assessed incidence of procedures to correct fistulae and drain abscesses for a UK cohort of patients being treated with infliximab.
Methods 18 UK centres participated in the study, including data from a total of 380 individuals with Crohn's disease who had received their first infusion of infliximab after 1 January 2003. Patients were eligible for inclusion with 12 months data prior to, and 24 months data post infliximab initiation, in their clinical record. Data on all investigations, clinic appointments, admissions and operations were extracted from the patient record in a standardised manner by members of the local clinical team. A prespecified statistical analysis plan compared healthcare resource utilisation at 12, 18 and 24 months after the introduction of infliximab with resource utilisation during the 12 months prior to starting treatment.
Results In the 12 month period before initiation of infliximab therapy there were a total of 32 procedures within the study population to correct fistulae, treat severe anal fistulae or drain abdominal or peri-rectal abscesses. In the 24-month period following initiation of infliximab therapy there were significantly fewer cumulative procedures (13 total). Procedures undertaken for correction of fistulae reduced from 12 (3.2% of patients) in 12 months pre-infliximab to 7 (1.9% of patients) in the 24 months following infliximab initiation (p<0.05). Treatment of severe anal fistulae was reduced from six cases (1.6%) to 2 (0.5%) (p<0.01). Procedures undertaken to drain either abdominal or peri-rectal abscesses reduced from 14 (3.7%) to 4 (1.1%) over the same period (p<0.0001).
Conclusion In a large UK cohort of Crohn's disease patients, treatment with infliximab was shown to significantly reduce the need for surgical procedures relating to either fistulae correction or drainage of abscesses
Competing interests C Wheeler: Employee of: MSD, R Chipperfield Employee of: MSD, T Orchard: Grant/Research Support from: MSD, Warner Chilcott, Johnson and Johnson, Consultant for: Warner Chilcott, Ferring, Shire, Speaker bureau with: Warner Chilcott, Ferring, Shire, J Lindsay: Grant/Research Support from: MSD, Abbott, Shire, Consultant for: MSD, Abbott, Shire, GSK, Ferring, Warner Chilcott, Atlantic Healthcare, Speaker bureau with: MSD, Abbott, Shire, Ferring, Warner Chilcott.
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