Anti-TNF with surgery yields favorable outcomes in Crohn’s perianal fistula
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Anti-tumor necrosis factor induction paired with surgical closure correlated with better long-term outcomes and decreased recurrence in patients with Crohn’s perianal fistulas, according to presented research.
“Perianal fistulas in patients with Crohn's disease can be quite difficult to close, and it is even more difficult to achieve true fistula healing,” Elise Meima-van Praag, MD, a PhD fellow in surgery at Amsterdam UMC, said. “To date only two randomized control trials directly compare medical to surgical treatment for Crohn's perianal fistulas. PISA-II, the patient-preference randomized control trial, showed comparable clinical closure rate and high radiological healing after short-term anti-TNF therapy combined with surgical closure compared to anti-TNF therapy alone. It is still unknown whether radiological healing at 18-months follow-up is associated with long-term clinical closure.”
To compare the long-term outcomes of both treatments, researchers followed 88 patients with Crohn’s perianal fistulas from the PISA-II trial who underwent either anti-TNF with surgical closure (n = 35) or anti-TNF therapy alone (n = 53). Studied endpoints included radiological healing at MRI, long-term clinical closure, recurrences, anti-TNF trough levels, incontinence and patient-reported decisional regret.
After a median follow-up of 5 years, radiological healing occurred in 40% of patients in the surgical closure group vs. 17% of patients in the anti-TNF treatment group (P = .018); long-term clinical closure was achieved in 71% and 60% of patients, respectively. Further analysis revealed recurrences in 20% of patients in the surgical closure group vs. 36% of patients in the anti-TNF group. Recurrences only occurred in patients without radiological healing.
Decisional regret analysis revealed all patients in the surgical closure group “strongly agreed” they made the right decision compared with 79% of patients in the anti-TNF group.
“This study showed favorable long-term outcomes of short-term anti-TNF therapy combined with surgical closure compared with anti-TNF therapy alone as treatment for Crohn's perianal fistula,” Meima-van Praag concluded. “We saw comparable clinical closure rates but only after reintervention in more than half of the anti-TNF therapy patients, and we saw earlier clinical closure after surgical closure and higher radiological healing rates.”
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Meima-van Praag E, et al. Abstract DOP30. Presented at: Congress of European Crohn’s and Colitis Organization; February 16-19, 2022 (virtual meeting).
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