The following is a summary of “Rates and Predictors of Long-term Clinical Outcomes in Patients With Perianal Crohn’s Disease on Biologic Therapy,” published in the July 2023 issue of the Clinical Gastroenterology by Gubatan et al.

Perianal Crohn’s disease (pCD) is a highly aggressive phenotype that has been the subject of limited research regarding its long-term outcomes. Researchers assessed the 5-year effects of these patients who underwent treatment with biological therapies. A retrospective analysis was conducted on patients diagnosed with pCD at a tertiary medical center. Kaplan-Meier curves were utilized to estimate rates, while multivariate logistic regression was employed to identify predictors of long-term outcomes in the medical context. Researchers enrolled 311 patients diagnosed with pCD, out of which 168 patients were initiated on biologic treatments. Among these, 138 patients received anti-tumor necrosis factor (TNF) α, 14 received vedolizumab, and 16 received ustekinumab. 

The utilization of anti-tumor necrosis factor (TNF) therapy upon initial diagnosis demonstrated a correlation with reduced occurrences of perianal abscess recurrence. This association was determined through hazard ratio (HR) analysis, yielding a value of 0.48, with a 95% CI ranging from 0.32 to 0.74. Conversely, the administration of ustekinumab was linked to heightened rates of perianal fistula closure (HR=3.58, 95% CI: 1.04-12.35) and diminished rates of perianal abscess recurrence (HR=0.20, 95% CI: 0.07-0.56) during subsequent evaluations. In patients who did not respond to their initial anti-tumor necrosis factor (anti-TNF) treatment, transitioning to another anti-TNF medication was linked to reduced rates of colectomy (hazard ratio [HR] = 0.20, 95% CI: 0.04-0.90) and permanent diversion (HR = 0.16, 95% CI: 0.03-0.94) when compared to ustekinumab. 

However, using vedolizumab was associated with decreased closure of perianal fistulas (HR = 0.22, 95% CI: 0.05-0.96) compared to ustekinumab. Factors that were found to be associated with the likelihood of undergoing colectomy included the presence of colonic disease (odds ratio=2.71, 95% confidence interval: 1.36-5.38) and anal stenosis (odds ratio=4.44, 95% confidence interval: 1.59-12.43). Utilizing a specific type of biologic treatment during the diagnosis of perianal Crohn’s disease (pCD) or following the failure of initial anti-tumor necrosis factor (anti-TNF) therapy could potentially impact the long-term results for patients with pCD.

Source: journals.lww.com/jcge/Abstract/2023/07000/Rates_and_Predictors_of_Long_term_Clinical.12.aspx