Topical Tacrolimus or Remicade?

[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,
Nancy

 

[xX_LittleMissValentine_Xx]

I'm sorry your post has gone unanswered for so long! I'm not sure what you mean by topical administration?
I have never heard of remicade being used any other way than by IV...

 

[BoyMama2000]

There are studies if you google (local administration of remicade or tacrolimus for perianal fistula) this that inject remicade into fistulas. They also inject tacrolimus. There is some good success with this. It is higher than with IV admin for fistula healing. It is also more localized and since my son does not require the power of a biologic for his small bowel disease right now, I would prefer this method but it is relatively new and may not be available outside of a research project. My son's Crohn's is limited to the superficial distal small intestine and is managed well with pentasa all of the time and Entocort in a flare. His flares are only detectable with fecal calprotectin. So far, he has no intestinal symptoms. He was diagnosed because his growth slowed and puberty was delayed. However, he did get a superficial fistula and abscess this spring that really effected his life for the first time.