Topic infliximab injection for refractory rectal stenosis in Crohn’s disease: long-term follow-up in two patients
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TNF blockers are approved for intravenous or subcutaneous systemic therapy of many chronic inflammatory diseases. As it is not possible to achieve a sufficient local clinical improvement through systemic therapy in every patient, diverse approaches of topical therapy using TNF blockers have been investigated in recent years.
In this paper, we report on long-term clinical results of originator infliximab (IFX) injections into symptomatic combined scarring and inflammatory stenoses of the rectum in two patients with Crohn’s disease. Aiming at high tissue IFX levels, 25 mg of IFX was injected into each quadrant of the stenosis after endoscopic balloon dilatation. This off-label treatment was repeated as necessary, depending on the clinical success.
Topic IFX injection after balloon dilation reduced imperative stool pressure, isolated episodes of incontinence and incomplete emptying. Improvement lasted between 4 and 14 weeks in one patient and the treatment was repeated 13 times in the following 6.6 years. In the other patient, the technique was necessary only twice with no symptom recurrence in the subsequent 5.3 years.
Our experience suggests that topic application of a systemically approved anti-TNF substance may be a successful individualized therapy for refractory stenosis of the rectum in patients with Crohn’s disease.
KeywordsInfliximab Crohn’s disease Rectal stenosis Endoscopic balloon dilation
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest. This study had no funding source.
- 1.Solberg IC, Vatn MH, Hoie O, Stray N, Sauar J, Jahnsen J, Moum B, Lygren I, IBSEN Study Group (2007) Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol 5:1430–1438. doi: 10.1016/j.cgh.2007.09.002 CrossRefPubMedGoogle Scholar
- 2.Bettenworth D, Gustavsson A, Atreja A, Lopez R, Tysk C, van Assche G, Rieder F (2017) A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing Crohn’s disease. Inflamm Bowel Dis 23:133–142. doi: 10.1097/MIB.0000000000000988 CrossRefPubMedGoogle Scholar
- 6.Ding NS, Yip WM, Choi CH, Saunders B, Thomas-Gibson S, Arebi N, Humphries A, Hart A (2016) Endoscopic dilatation of Crohn’s anastomotic strictures is effective in the long term, and escalation of medical therapy improves outcomes in the biologic era. J Crohns Colitis 10:1172–1178. doi: 10.1093/ecco-jcc/jjw072 CrossRefPubMedGoogle Scholar
- 8.van der Have M, Noomen C, Oldenburg B, Walter D, Houben MH, Wasser MN, Siersema PD, Hommes D, Fidder HH (2015) Balloon dilatation with or without intralesional and oral corticosteroids for anastomotic Crohn’s disease strictures. J Gastrointestin Liver Dis 24:537–539. doi: 10.15403/jgld.2014.1121.244.hav PubMedGoogle Scholar
- 14.Conti F, Ceccarelli F, Priori R, Iagnocco A, Signore A, Valesini G (2008) Intra-articular infliximab in patients with rheumatoid arthritis and psoriatic arthritis with monoarthritis resistant to local glucocorticoids. Clinical efficacy extended to patients on systemic anti-tumour necrosis factor alpha. Ann Rheum Dis 67:1787–1790. doi: 10.1136/ard.2008.091900 CrossRefPubMedGoogle Scholar
- 15.Poggioli G, Laureti S, Pierangeli F, Rizzello F, Ugolini F, Gionchetti P, Campieri M (2005) Local injection of infliximab for the treatment of perianal Crohn’s disease. Dis Colon rectum 48:768–774. doi: 10.1007/s10350-004-0832-4
- 16.Asteria CR, Ficari F, Bagnoli S, Milla M, Tonelli F (2006) Treatment of perianal fistulas in Crohn’s disease by local injection of antibody to TNF-alpha accounts for a favourable clinical response in selected cases: a pilot study. Scand J Gastroenterol 41:1064–1072. doi: 10.1080/00365520600609941 CrossRefPubMedGoogle Scholar
- 19.Tonelli F, Giudici F, Asteria CR (2012) Effectiveness and safety of local adalimumab injection in patients with fistulizing perianal Crohn’s disease: a pilot study. Dis Colon rectum 55:870–875. doi: 10.1097/DCR.0b013e31825af532
- 22.Conti F, Malviya G, Ceccarelli F, Priori R, Iagnocco A, Valesini G, Signore A (2012) Role of scintigraphy with (99m)Tc-infliximab in predicting the response of intraarticular infliximab treatment in patients with refractory monoarthritis. Eur J Nucl Med Mol Imaging 39:1339–1347. doi: 10.1007/s00259-012-2133-9 CrossRefPubMedGoogle Scholar
- 23.Atreya R, Neumann H, Neufert C, Waldner MJ, Billmeier U, Zopf Y, Willma M, App C, Münster T, Kessler H, Maas S, Gebhardt B, Heimke-Brinck R, Reuter E, Dörje F, Rau TT, Uter W, Wang TD, Kiesslich R, Vieth M, Hannappel E, Neurath MF (2014) In vivo imaging using fluorescent antibodies to tumor necrosis factor predicts therapeutic response in Crohn’s disease. Nat Med 20:313–318. doi: 10.1038/nm.3462 CrossRefPubMedPubMedCentralGoogle Scholar