Perianal involvement links to poor outcomes in Crohn’s disease
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Patients with perianal Crohn’s disease had worsened disease outcomes compared with patients with Crohn’s disease alone, according to research published in Clinical Gastroenterology and Hepatology.
“The presence of fistulizing perianal disease has been implicated as a significant predictor for which early intensified treatment is warranted both in adults and children. ... Multiple studies have indicated that perianal CD (PCD) is associated with more severe disease,” Ohad Atia, MD, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel, and colleagues wrote. “We thus aimed to evaluate the perianal involvement in a population-based cohort of CD and to explore the incidence, management and outcomes of CD patients with and without perianal involvement.”
Using data from the epidemiology group of the Israeli IBD Research Nucleus cohort, researchers analyzed 12,905 patients with CD (83% adults) for disease-related outcomes 5-years post-diagnosis. Researchers further investigated time to outcome between patients with PCD (12%) vs. patients without PCD and estimated adjusted predictors for poorer outcomes.
Researchers reported the prevalence of PCD was 7.9% 1-year post-CD diagnosis and 9.4%, 10.3% and 11.6% at 3-years, 5-years and 10-years post-CD diagnosis, respectively. Among patients with PCD, 11% developed perianal disease despite prior biologic treatment. Further, compared with patients without PCD, patients with PCD were more likely to be hospitalized (36% vs. 64%; OR = 3.16; 95% CI, 2.81-3.37), undergo IBD-related surgeries (9% vs. 38%; OR = 6.42; 95% CI, 6.03-7.31) and develop anorectal cancer (1.2/10,000 person-years vs. 4.2/10,000 person-years; OR = 4.67; 95% CI, 1.51-14.27) at 5-years post-diagnosis.
Predictors of perianal involvement included male sex (HR = 1.63; 95% CI, 1.4-1.89) and induction therapy with a systemic steroid (HR = 1.32; 95 % CI, 1.12-1.56). Researchers noted severe PCD associated with the worst disease outcomes.
“The presence of perianal disease is associated with poorer outcome, particularly for severe PCD, despite higher utilization of immunosuppressant medications and biologics,” Atia and colleagues concluded. “Our data should be considered in clinical decision making of selecting the most appropriate patients for early intensified medical treatment as well as for cancer surveillance.”
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