Study Highlights Effectiveness of Medical Therapies for Fistulizing Crohn’s Disease

Medical therapies including tumor necrosis factor inhibitors (TNFis), oral small molecules, ustekinumab, and mesenchymal stem cell (MSC) therapy offer promising results for perianal fistulizing CD, authors of a systematic review stated in the Journal of Crohn's and Colitis.

Researchers reviewed 38 randomized controlled trials (RCTs) involving adults with fistulizing CD. The primary outcomes were induction and maintenance of fistula response, with pooled risk ratios (RRs) and 95% confidence intervals (CIs) calculated. Evidence certainty was evaluated using the GRADE framework.

Half of the included studies exclusively focused on perianal fistulas, while others included nonperianal fistulas. TNFi agents did not achieve statistically significant results for induction (RR 1.36; 95% CI 0.97-1.91) or maintenance (RR 1.48; 95% CI 0.97-2.27) of fistula response. However, sensitivity analyses of trials targeting fistula response as a primary outcome revealed anti-TNFs were effective for both induction (RR 1.94; 95% CI 1.10-3.41) and maintenance (RR 1.88; 95% CI 1.23-2.88).

Oral small molecules (RR 2.56; 95% CI 1.18-5.53) and MSC therapy (RR 1.26; 95% CI 1.01-1.57) demonstrated efficacy in inducing fistula response. Ustekinumab was effective for maintaining fistula response (RR 1.80; 95% CI 1.04-3.11), while vedolizumab showed no significant benefit over placebo. The certainty of evidence ranged from very low to moderate.

The authors noted that further RCTs specifically targeting fistulizing CD are needed to strengthen the evidence base and guide clinical decision-making.

Reference
Vuyyuru SK, Solitano V, Narula N, et al. Pharmacological therapies for the management of fistulizing crohn's disease: A systematic review and meta-analysis. J Crohns Colitis. 2024;18(4):589-603. doi:10.1093/ecco-jcc/jjad185