Topical Remicade for Periana Fistulas?

[BoyMama2000]

Hi Everyone,

I have read some promising research about topical administration of both remicade and tacrolimus to heal perianal fistulas.

My son has Crohns limited to the distal small bowel and only on the inner surface but had a perianal fistula this spring. He has normal bowel movements but was diagnosed due to lack of growth 18 months ago. The fistula was simple and superficial. His FCP went from 700-100 after 4 weeks on Entocort and his fistula healed with cipro and/or Entocort. They plan to keep him on pentasa and Entocort for now but we also want to plan if the fistula returns. We are taking the hope for the best and plan for the worst approach.

His doctor is open to trying topical tacrolimus or remicade but we can't find anyone in the Denver area who does this. Do any of you know anyone who does this? We may be willing to travel if needed.

Thanks.

 

[Essieluv]

I have never heard of this, it is really interesting. I have perianal Crohn's along with Crohn's in many other places, and have had fistulas and abscesses. Do you know if someone is allergic to Remicade, can they use topical Remicade? That sounds like a dumb question, but it is worth an ask. I hope you are able to find someone to provide these options for your son.

 

[BoyMama2000]

Google topical remicade and tacrolimus. If you are allergic to remicade, perhaps tacrolimus could work. I doubt you could use injectable remicade in fistulas if you are allergic as some will always go systemic. Do you notice that your perianal disease flares with proximal disease or are they separate? What have you used successfully?

 

[Sarahnarizona]

Is your Dr. willing to give this treatment but unable to find it? Or is he willing to let another Dr. treat your son? Anyway you may want to talk to him about a compounding pharmacy in your area. If we have several here in Phoenix I am sure there are several in Denver area.

Not sure if this will be a dead end or not. Just an idea...sometimes all it takes a bread crumb to lead to the loaf!

 

[BoyMama2000]

It is administered by an injection into the fistula track. His fistula healed with antibiotics but we want a plan if he gets another one. He takes Pentasa for terminal small bowel crohns that is superficial. He is also now on Entocort and weaned down to 6mg.

If he gets another fistula, the plan is to put him on methotrexate but he is also open to having a doctor do the remicade or tacrolimus injections that are local. We just need to find someone and there is no one at his Children's hospital or the medical school adult hospital affiliated with it. His surgeon may be willing to do it. I just sent him some articles but was wondering if anyone on this site had this done. It may only be offered as a part of a research project at this time.

 

[mish2575]

I wonder if cizma would work.

 

[BoyMama2000]

It makes a lot of sense to me to try local injections of these meds. They are less effective for perianal issues than proximal disease and studies are showing they work better this way. It would be a win-win for those who don't have serious proximal disease and those who do but the IV administration doesn't work. If it takes less medication, it may also eventually be a cost saver.

I sure hope they make gains with this research! If remicade works, I have no idea why Cimza would be different.

 

[mish2575]

If I get put on cizma, I might consider doing it myself to a few HS spots (which biologics are supposed to help)

 

[Cardsfan2]

Hi there. My husbands dr requested he look into having the local injections of remicade to treat his fistula. There is a dr at Barnes Jewish hospital in St. Louis mo. The dr name is Guteriez. We have not met her yet but will be looking into this more. happy to hear your sons healed with antibiotics. We will look into the local injections & keep you updated.

 

[BoyMama2000]

Please let us know how this goes. It could be a really nice option for all of us! You are lucky to have someone in your area who does this. We don't have anyone in Colorado.

 

[Cardsfan2]

We will keep you updated. I am hoping he gets an appointment this week to meet with the Dr that will do the injetions.

 

[BoyMama2000]

Best of luck!

 

[Lisa]

I only found information on topical tacro (protopic), nothing on using Remicade topically....

 

[Clash]

Here is a case study on local injections, pasobuff:

It has recently been suggested that local injections of infliximab might be beneficial as well. The aim of this study was to assess whether infliximab could play an effective role in the local treatment of perianal fistulas in Crohn's disease

Local infliximab injections were administered to 11 patients suffering from Crohn's disease complicated by perianal disease. Eligible subjects included Crohn's disease patients with single or multiple draining fistulas, regardless of status of luminal disease at baseline. Patients, however, were excluded from the study if they had perianal or rectal complications, such as abscesses or proctitis or if they had previously been treated with infliximab. Twenty-milligram doses of infliximab were injected along the fistula tract and around both orifices at baseline and then every 4 weeks for up to 16 weeks or until complete cessation of drainage.

Overall, 8/11 patients (72.7%) responded to the therapy and 4/11 (36.4%) reached remission, whereas 3/11 patients (27.2%) showed no response. Response or remission was very much dependent on the location of the fistulas, and time to loss of response was generally longer for patients who reached remission compared to patients in response.

source

 

[Lisa]

Thanks Clash.....looks like this was done/published back in 2006. Wonder if any additional studies were done or are in progress.

 

[Clash]

Not sure, I didn't really go through all the links when I posted just to the one I had seen previously. I just searched through google scholar.

Here is a link to another study but not sure if it is relevant as I didn't read through it just posted from title:

http://www.giejournal.org/article/S0016-5107(05)02756-2/abstract

sorry, I'm on my way out the door, I'll check some other sites when I get back.