Anti‐<scp>TNF</scp> therapy for genital fistulas in female patients with Crohn's disease: a nationwide study from the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID)

Baut, G. Le; Peyrin–Biroulet, Laurent; Bouguen, Guillaume; Gornet, Jean–Marc; Stéfanescu, Carmen; Amiot, Aurélien; Laharie, David; Altwegg, Romain; Fuméry, Mathurin; Trang, Caroline; Vuitton, Lucine; Simon, M.; Joseph, Cyrielle Gilletta de Saint; Nahon, Stéphane; Caillo, Ludovic; Tedesco, Émilie Del; Aubourg, Alexandre; Chambrun, Guillaume Pineton de; Seksik, Philippe; Viennot, Stéphanie

doi:10.1111/apt.14946

Cited by 3 publications

(3 citation statements)

References 34 publications

(127 reference statements)

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“…Studies found that the introduction of biologics after internal and external intestinal fistulas formation allowed patients to avoid surgery for a prolonged period of time [12,14]. Multiple studies from France showed that closure of rectovaginal fistulas was effectively induced after Infliximab treatment [25,26]. Although after anti-TNF treatment, a large number of fistulas healed and surgery is thus delayed, data obtained from our study also suggested that, despite the effectiveness of biologics, which may delay the requirement of surgical resection, the majority of patients require surgery in 3 years.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of intestinal penetrating Crohn’s disease following successful nonoperative management

Sun,

Cao,

Chen

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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There is a paucity of data on the surgical or medical treatment for abscess/fistula complicating Crohn’s disease after successful nonsurgical management. We conducted a cohort study to investigate the long-term outcomes and the risk factors for the requirement of subsequent surgical intervention in Crohn’s disease patients with complicating fistulas/abscess following successful nonsurgical management. Data were collected on penetrating Crohn’s disease experiencing successful nonsurgical treatment between December 2012 and December 2021. Long-term outcomes and risk factors of surgery were assessed by univariate and multivariate analysis, and subgroup analysis was performed based on penetrating phenotype including abscess, fistula, and phlegmon. A total of 523 penetrating Crohn’s disease patients; there were 390, 125, and 60 patients complicated with fistulas, abscess, and phlegmon, respectively. Long-term outcomes showed that BMI < 18.5 (kg/m2), the recurrent abscess, and stricture were independent risk factors of surgery. Biologics and resolution of abscess were independent protective factors of surgery. Furthermore, in 399 patients undergoing early surgery, stricture and BMI < 18.5 (kg/m2) were independent risk factors, and biologics and abscess resolution were protective of the early surgery. Subgroup analysis based on fistula, abscess, and phlegmon phenotype also demonstrated that concomitant stricture was an independent risk factor and the use of biologics was protective of surgical resection. Our data indicate that biologics can delay the requirement of surgery and may be given to patients with penetrating complicating Crohn’s disease who have been successfully treated nonoperatively, but surgical resection should be considered in the setting of malnutrition and stenosis formation.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes of intestinal penetrating Crohn’s disease following successful nonoperative management

Sun,

Cao,

Chen

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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“…The overall response rate was 63%, and 37% of patients had no response [ 104 ]. In 2018, a large national-wide retrospective cohort reported on 204 patients with RV fistulas who received anti-TNF (79% infliximab, 20% adalimumab and 1% certolizumab), where 37% had complete fistula closure and 22% had a partial response at 1-year follow-up [ 105 ]. One case report of combined dual biologic therapy with VDZ and UST showed a successful fistula closure in a patient with a refractory RV fistula [ 109 ].…”

Section: Medical Treatment For Non-perianal Fistulizing CDmentioning

confidence: 99%

The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials

Wetwittayakhlang

Khoury

Hahn

et al. 2022

JCM

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Fistulizing Crohn’s disease (FCD) remains the most challenging aspect of treating patients with CD. FCD can occur in up to 30% of patients with CD and may lead to significant disability and impaired quality of life. The optimal treatment strategies for FCD require a multidisciplinary approach, including a combined medical and surgical approach. The therapeutic options for FCD are limited due to sparse evidence from randomized clinical trials (RCTs). The current recommendations are mainly based on post hoc analysis from RCTs, real-world clinical studies and expert opinion. There is variation in everyday clinical practice amongst gastroenterologists and surgeons. The evidence for anti-tumor necrosis factor therapy is the strongest in the treatment of FCD. However, long-term fistula healing can be achieved in only 30–50% of patients. In recent years, emerging data in the advent of therapeutic modalities, including the use of new biologic agents, therapeutic drug monitoring, novel surgical methods and mesenchymal stem cell therapy, have been shown to improve outcomes in achieving fistula healing. This review summarizes the existing literature on current and emerging therapies to provide guidance beyond RCTs in managing FCD.

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“…7 Moreover, the progressive nature of CD in the postoperative period, 8 requirement for repeated resections, and significant morbidity are major limitations to considering surgery the first-line therapy for fistulizing CD. The evidence of anti-TNF agents in patients with nonperianal fistulizing CD is also limited to a few retrospective cohort studies, [9][10][11][12] with most prospective controlled studies including perianal fistulae and excluding internal fistulae. [13][14][15] Furthermore, the efficacy of anti-TNF is considered low in this subgroup, 13,14,16 and it is limited by infectious side effects, including the high risk of tuberculosis (TB), especially in TB-endemic Asian countries.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of anti‐tumor necrosis factor therapy and surgery in nonperianal fistulizing Crohn's disease

et al. 2021

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Background Unlike perianal fistula, long‐term outcomes of nonperianal fistulae (NPF) in Crohn's disease (CD) are not clear. We aimed to compare the outcomes of medical and surgical therapies in patients with NPF. Methods We retrospectively analyzed the records of patients of CD with NPF who were prospectively followed from January 2005 to December 2018. Results Of the 53 patients with NPF [mean age at presentation:29 ± 14 years; 54.7% male; median duration of follow‐up: 47 months (interquartile range [IQR]:26–76 months)], enteroenteric fistula (37.8%) was the most common presentation. Of 22 patients treated with anti‐tumor necrosis factor (TNF) therapy, complete response was achieved in 40.9% (n = 9). Overall probability of maintaining response was similar between the anti‐TNF and surgical groups (95.2% vs 82.4%; 71% vs 76%; and 63% vs 69%% [P = 0.8] at 1, 2, and 3 years, respectively), with only 13.6% of patients treated with biologicals requiring surgery over 56 months. Twenty‐one patients required upfront surgery (small bowel or ileocolonic resection with/without diversion; 28.5% emergent), with 47.6% postoperative recurrence over 36 months, of which nine patients required biologicals (77.7% response to anti‐TNF therapy). Long‐term outcome was comparable between medically and surgically treated patients; 6.4% developed tuberculosis on anti‐TNF therapy. Two patients (3.7%) developed malignancy (one ‐ enteroenteric, one ‐ colovesical). Conclusion Anti‐TNF therapy appears to be as effective as surgery in this retrospective analysis of patients with NPFCD, and it may be indicated in the absence of abscess and other complications. These patients are at higher risk of fistula‐associated malignancy, which requires a lower threshold for suspicion, especially over the long term in the presence of nonresponse to medical therapy.

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Anti‐TNF therapy for genital fistulas in female patients with Crohn's disease: a nationwide study from the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID)

Abstract: In the anti-TNF era, approximately one-third of patients with genital fistula in Crohn's disease had complete fistula closure at 1 year. Collaboration between surgeons and gastroenterologists appears to be very important to improve the rate of fistula closure.

Cited by 3 publications

References 34 publications

Long-term outcomes of intestinal penetrating Crohn’s disease following successful nonoperative management

Long-term outcomes of intestinal penetrating Crohn’s disease following successful nonoperative management

The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials

Long‐term outcomes of anti‐tumor necrosis factor therapy and surgery in nonperianal fistulizing Crohn's disease

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