The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study

Scheer, Sebastian; Black, Christopher J; Pugliese, Daniela; Armuzzi, Alessandro; Sahnan, Kapil; Elkady, Soad; Katsanos, K.H.; Christodoulou, Demitrios K.; Selinger, Christian P.; Maconi, Giovanni; Fearnhead, Nicola; Kopylov, Uri; Davidov, Yana; Bosca-Watts, Marta Maia; Ellul, Pierre; Muscat, Mark; Karmiris, Konstantinos; Hart, Ailsa; Danese, Silvio; Ben‐Horin, Shomron; Fiorino, Gionata

doi:10.1111/apt.14969

Cited by 27 publications

(26 citation statements)

References 39 publications

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“…In solutions try to address this issue, we used the need for stula-related re-intervention as the primary endpoint. Since repeat surgery may act as a surrogate marker for stula relapse and avoiding this event is the essential goal for PFCD management [30][31][32]. In the current study, 30% of patients required at least one repeat surgery through the follow-up period.…”

Section: Discussionmentioning

confidence: 68%

Combined Therapy With Early Initiation of Infliximab After Surgery for Perianal Fistulising Crohn’s Disease : A Retrospective Cohort Study

Zhu¹,

Jin²,

Gu³

et al. 2021

Preprint

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Background: Recent studies have recognized that combined surgery and anti-TNF therapy could improve clinical outcomes in patients with perianal fistulising Crohn’s disease (PFCD). However, the optimal timing for infliximab infusion after surgical intervention is uncertain. We aimed to determine the long-term efficacy of early initiation of infliximab after surgery among patients who received combination therapy for PFCD.Methods: We performed a retrospective cohort study of PFCD patients who received combined infliximab and surgical treatment between 2010 and 2018 at a tertiary referral hospital. Patients were grouped according to the time interval between surgery and infliximab infusion, with < 6 weeks into early combination group and > 6 weeks into conventional combination group. The primary outcome was to compare fistula closure and surgical re-intervention between early and conventional combination groups. The secondary outcomes were predictors associated with these outcomes of early combination approach.Results: One hundred and seventeen patients were included (73 in early combination, 44 in conventional combination). The median interval between surgery and initial infliximab infusion was 9.0 (IQR 5.5-17.0) days in early combination group and 188.0 (IQR 102.25-455.75) days in conventional combination group. After followed-up for a median of 36 months, 61.6% of patients in early combination group and 65.9% patients in conventional combination group derived fistula closure (p=0.643). The cumulative re-intervention rate was 23%, 32%, 35% in early combination group and 16%, 24%, 24% in conventional combination group, at 1, 2, and 3 years respectively (P=0.235). Presence of abscess (HR = 5.283; 95% CI, 1.61-17.335; p = 0.006) and maintenance infliximab therapy > 3 times (HR = 3.691; 95% CI, 1.233-11.051; p = 0.02) were associated with re-intervention in early combination group. Presence of abscess also negatively influences fistula closure (HR = 3.429, 95% CI, 1.216-9.668; p = 0.02).Conclusion: Combined therapy with early initiation of infliximab after surgery could achieve promising results for PFCD patients. Durable drainage should be established for patients with concomitant abscess or requiring infliximab maintenance before infliximab initiation.

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Section: Discussionmentioning

confidence: 68%

Combined Therapy With Early Initiation of Infliximab After Surgery for Perianal Fistulising Crohn’s Disease : A Retrospective Cohort Study

Zhu¹,

Jin²,

Gu³

et al. 2021

Preprint

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“…Benefit has been shown for adjunctive use of antibiotics (ciprofloxacin) during induction and optimization of luminal activity, in particular proctitis. 24,25 Conflict of Interest/Disclosures Dr Astrid-Jane Williams has received honoraria from Takeda, Janssen, and Abbvie; and honoraria and grant support from Ferring.…”

Section: Perianalmentioning

confidence: 99%

“…It is recognized that perianal disease may require treatment with higher drug concentrations than luminal disease; however, the optimal target drug concentrations remain uncertain. Benefit has been shown for adjunctive use of antibiotics (ciprofloxacin) during induction and optimization of luminal activity, in particular proctitis 24,25 …”

Section: Perianalmentioning

confidence: 99%

Advanced therapies in inflammatory bowel disease: Special considerations

Williams

2021

J of Gastro and Hepatol

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“…5,[16][17][18] About 70% of patients with PFCs eventually undergo surgical interventions, which often provide only temporary relief. 6,17,19 Despite all available medical and surgical interventions, 8%…”

Section: Introductionmentioning

confidence: 99%

Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

et al. 2020

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IMPORTANCE Perianal fistulizing complications (PFCs) develop in 15% to 30% of patients with Crohn disease (CD), are difficult to treat, worsen quality of life, increase cost of care, and commonly recur. Evidence-based strategies to prevent PFCs are lacking. OBJECTIVES To investigate the effectiveness of medical therapy for reducing risk of PFCs among young people with CD and to test the hypothesis that steroid-sparing therapy (SST) use would be associated with reduced risk of PFC development.

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The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study

Abstract: Multimodality treatment, anti-TNFs use, and removal of setons after multimodality treatment can result in improved outcomes in CD patients with perianal fistulae and reduce the need for repeat surgery and radical surgery.

Cited by 27 publications

References 39 publications

Combined Therapy With Early Initiation of Infliximab After Surgery for Perianal Fistulising Crohn’s Disease : A Retrospective Cohort Study

Combined Therapy With Early Initiation of Infliximab After Surgery for Perianal Fistulising Crohn’s Disease : A Retrospective Cohort Study

Advanced therapies in inflammatory bowel disease: Special considerations

Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

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