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Pharmacological Approach to the Management of Crohn’s Disease Patients with Perianal Disease

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Abstract

Perianal localization of Crohn’s disease involves significant morbidity, affects quality of life and results in an increased use of healthcare resources. Medical and surgical therapies contribute to its management. The objective of this review is to address the current understanding in the management of perianal Crohn’s disease, with the main focus in reviewing pharmacological therapies, including stem cells. In complex fistulas, once local sepsis has been controlled by surgical drainage and/or antibiotics, anti-TNF drugs (infliximab, adalimumab) are the first-line therapy, with or without associated immunomodulators. Combining surgery and anti-TNF therapy has additional benefits for healing. However, response is inadequate in up to half of cases. A possible role of new biological drugs in this context (vedolizumab, ustekinumab) is an area of ongoing investigation, as is the local application of autologous or allogeneic mesenchymal stem cells. These are non-hematopoietic multipotent cells with anti-inflammatory and immunomodulatory properties, the use of which may successfully treat refractory patients, and seem to be a promising and safe alternative to achieving fistula healing in Crohn’s disease, without known systemic effects.

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Authors and Affiliations

  1. Department of Gastroenterology, University Hospital of Fuenlabrada, Madrid, Spain

    Fernando Bermejo, Iván Guerra & Alicia Algaba

  2. Department of Medicine and Surgery, Universidad Rey Juan Carlos, Madrid, Spain

    Fernando Bermejo

  3. Department of Gastroenterology and Hepatology, University Hospital Ramón y Cajal, Madrid, Spain

    Antonio López-Sanromán

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Fernando Bermejo has served as a speaker, a consultant and advisory member for MSD, Abbvie, Pfizer, Hospira, Takeda, Janssen and Gebro. Antonio López-Sanromán has served as a speaker, a consultant and advisory member for MSD, Abbvie, Pfizer, Takeda, Janssen, Ferring and Tigenix, and has received grants from MSD and Abbvie. Iván Guerra y Alicia Algaba has no conflicts of interest to declare.

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Bermejo, F., Guerra, I., Algaba, A. et al. Pharmacological Approach to the Management of Crohn’s Disease Patients with Perianal Disease. Drugs 78, 1–18 (2018). https://doi.org/10.1007/s40265-017-0842-x

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