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Silvio Danese, Tommaso Stefanelli, Paolo Omodei, Stefania Zatelli, Cristiana Bonifacio, Luca Balzarini, Alessandro Repici, Alberto Malesci, Successful treatment of fistulizing Crohn's disease with certolizumab pegol, Inflammatory Bowel Diseases, Volume 14, Issue 2, 1 February 2008, Pages 292–293, https://doi.org/10.1002/ibd.20284
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To the Editor:
Treatment of fistulizing Crohn's disease (CD) is still a challenge for gastroenterologists taking care of inflammatory bowel disease (IBD) patients, particularly if conventional medical therapies fail. Here we report a successful treatment with certolizumab pegol, a pegylated humanized Fab′ fragment with a high binding affinity for tumor necrosis factor alpha, in a fistulizing CD patient resistant to conventional therapies.
The patient is a 37-year-old female with a 24-year-long history of CD, localized to the ileum and the colon. She was intolerant to azathioprine therapy and for the last 20 years she received several cycles of steroid therapy, with poor control of the disease. In 2004 she was treated with infliximab, but she had an anaphylactic shock reaction to the drug.
Because of stenosis and intestinal occlusions, the patient had 4 surgical interventions leading to a definitive ileostomy. When the patient came to our observation, she had an enterocutaneous fistula in the right flank and moderate disease activity (Fig. 1A). She had moderate abdominal pain, hemoglobin 10.6 mg/dL, hematocrit 29%, platelet count 470 × 106, ESR 69 mm/h, and CRP 34 mg/L. Magnetic resonance imaging (MRI) was performed, demonstrating an enterocutaneous fistula 5 cm long (Fig. 1B, see arrows). We prescribed two high-dose cycles of antibiotic therapies with ciprofloxacine and metronidazole (1 g/day) with no benefit.
