Intest Res  
Clinical efficacy of adalimumab versus infliximab and the factors associated with recurrence or aggravation during treatment of anal fistulas in Crohn’s disease
Cheng-Chun Ji, Shota Takano
Coloproctology Center, Takano Hospital, Kumamoto, Japan
Correspondence to: Shota Takano, Coloproctology Center, Takano Hospital, 4-2-88 Obiyama, Chuo-ku, Kumamoto 862-0924, Japan. Tel: +81-96-384- 1011, Fax: +81-96-385-2890, E-mail: micg@takano-hospital.jp
Received: August 10, 2016; Revised: October 6, 2016; Accepted: October 12, 2016; Published online: March 14, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Infliximab has proven to be effective in the treatment of perianal fistulas in Crohn’s disease but the efficacy of adalimumab is still unclear. The aim of this study is to assess the clinical efficacy of adalimumab and compare the results with those for infliximab. Methods: Forty-seven Crohn’s disease patients treated for perianal fistulas with infliximab from September 2005 to December 2010 (n=31), or with adalimumab from November 2010 to May 2012 (n=16), were enrolled in this retrospective study. The following patient characteristics were analyzed; intestinal lesion site, fistula classification, seton placement, index of inflammatory bowel disease, C-reactive protein level, follow-up period, and the cumulative rate of nonrecurrence or aggravation of fistula. Results: There were no significant differences in the intestinal lesion site, fistula classification, inflammatory bowel disease index, C-reactive protein level, and the frequency of injection between the infliximab group and the adalimumab group. The cumulative rate of nonrecurrence or aggravation of fistula was 62.5% in the adalimumab group and 83.9% in the infliximab group at 24 months after treatment (P =0.09). The risk factors for recurrence or aggravation may be related to seton placement (P =0.02), gender (P =0.06), and fistula classification (P =0.07). Conclusions: There was no significant difference in the clinical efficacy of adalimumab and infliximab in the treatment of perianal fistulas in Crohn’s disease. However, fistula classification may be an important risk factor for recurrence or aggravation. The preliminary findings in this study show that further research is warranted.
Keywords: Crohn disease; Perianal fistula; Adalimumab; Infliximab


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