randomized clinical trials in perianal disease.

Research output: Contribution to journalReview articlepeer-review


Abstract: Crohn’s disease can be complicated by the development of fistulas, 54% of which involve the perianal region.The presence of perianal fistulas predicts a disabling course of Crohn’s disease.The treatment of complex perianal disease is difficult and the chance of complete fistula healing is no more than 50%. Thebest management of this condition is a combining medical and surgical therapy. Studies which evaluated the efficacy ofmedical treatments in this setting are small, open label and considered the efficacy on perianal disease as a second outcomeor as the result of a subgroup analysis. In the few available trials the efficacy outcomes were evaluated by the FistulaDrainage Assessment but recently it was observed that inflamed fistula tracks often persist, despite the apparent closureof external orifices.Up to now the most strongly evaluated medical treatments for perianal Crohn’s disease are the anti-TNF antibodies. Inpresence of complex fistulas they are considered the first choice of medical treatment, in combination with surgical therapy.Antibiotics and immunomodulators have not been demonstrated to result in sustained closure of fistulas in Crohn’sdisease. Their use is recommended as a second line medical treatment. The use of tacrolimus and thalidomide is limitedby its side effects. A few evidences support the use of methotrexate and cyclosporine but they are insufficient.
Original languageEnglish
Pages (from-to)297-392
Number of pages5
JournalReviews on Recent Clinical Trials
Publication statusPublished - 2012

All Science Journal Classification (ASJC) codes

  • Pharmacology

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