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The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study
Author(s) -
Sebastian Shaji,
Black Christopher,
Pugliese Daniela,
Armuzzi Alessandro,
Sahnan Kapil,
Elkady Soad M.,
Katsanos Kostas H.,
Christodoulou Demitrios K.,
Selinger Christian,
Maconi Giovanni,
Fearnhead Nicola S.,
Kopylov Uri,
Davidov Yana,
BoscaWatts Marta M.,
Ellul Pierre,
Muscat Martina,
Karmiris Konstantinos,
Hart Ailsa L.,
Danese Silvio,
BenHorin Shomron,
Fiorino Gionata
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14969
Subject(s) - medicine , infliximab , proctitis , adalimumab , fistula , retrospective cohort study , surgery , crohn's disease , radical surgery , disease , ulcerative colitis , cancer
Summary Background Treatment paradigms for Crohn′s disease with perianal fistulae (CD‐pAF) are evolving. Aims To study the impact of multimodality treatment in CD‐pAF on recurrence rates and the need for re‐interventions and to identify predictive factors for these outcomes. Methods This was a multinational multicentre retrospective cohort study. Multimodality approach was defined as using a combination of medical treatments (anti‐TNFs ± immunomodulators ± antibiotics) along with surgical approach (examination under anaesthesia (EUA) ± seton drainage) at diagnosis of CD‐pAF. Univariable and multivariable analyses were performed for variables indicative of the need for reintervention. Results A total of 253 patients were included. 65% of patients received multimodality approach. Multimodality treatment resulted in complete fistula healing in 52% of patients. Re‐intervention was needed in 27% of patients with simple and in 40.3% of those with complex fistula. On multivariable analysis multimodality treatment (OR: 0.35, 95% CI: 0.17‐0.57, P = 0.001), seton removal (OR: 0.090, 95% CI: 0.027‐0.30, P = 0.0001, therapy with infliximab (OR: 0.19, 95% CI: 0.06‐0.64, P = 0.007), and therapy with adalimumab (OR: 0.12, "95% CI: 0.026‐0.56, P = 0.007) were predictive of avoiding repeat surgery. Proctitis (OR: 3.76, 95% CI: 1.09‐12.96, P = 0.03) was predictive of the need for radical surgery (proctectomy, diverting stoma) while multimodality treatment reduced the need for radical surgery (OR: 0.21, 95% CI: 0.05‐0.81, P = 0.02). Conclusions 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.