The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study

Shaji Sebastian, Christopher Black, Daniela Pugliese, Alessandro Armuzzi, Kapil Sahnan, Soad M. Elkady, Kostas H. Katsanos, Demitrios K. Christodoulou, Christian Selinger, Giovanni Maconi, Nicola S. Fearnhead, Uri Kopylov, Yana Davidov, Marta M. Bosca-Watts, Pierre Ellul, Martina Muscat, Konstantinos Karmiris, Ailsa L. Hart, Silvio Danese, Shomron Ben-HorinGionata Fiorino

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)941-950
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume48
Issue number9
DOIs
Publication statusPublished - Nov 1 2018

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Combined Modality Therapy
Crohn Disease
Fistula
Cohort Studies
Retrospective Studies
Therapeutics
Reoperation
Proctitis
Immunologic Factors
Drainage
Anesthesia
Anti-Bacterial Agents
Recurrence

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Cite this

The role of multimodal treatment in Crohn′s disease patients with perianal fistula : a multicentre retrospective cohort study. / 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; Bosca-Watts, Marta M.; Ellul, Pierre; Muscat, Martina; Karmiris, Konstantinos; Hart, Ailsa L.; Danese, Silvio; Ben-Horin, Shomron; Fiorino, Gionata.

In: Alimentary Pharmacology and Therapeutics, Vol. 48, No. 9, 01.11.2018, p. 941-950.

Research output: Contribution to journalArticle

Sebastian, S, Black, C, Pugliese, D, Armuzzi, A, Sahnan, K, Elkady, SM, Katsanos, KH, Christodoulou, DK, Selinger, C, Maconi, G, Fearnhead, NS, Kopylov, U, Davidov, Y, Bosca-Watts, MM, Ellul, P, Muscat, M, Karmiris, K, Hart, AL, Danese, S, Ben-Horin, S & Fiorino, G 2018, 'The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study', Alimentary Pharmacology and Therapeutics, vol. 48, no. 9, pp. 941-950. https://doi.org/10.1111/apt.14969
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 ; Bosca-Watts, Marta M. ; Ellul, Pierre ; Muscat, Martina ; Karmiris, Konstantinos ; Hart, Ailsa L. ; Danese, Silvio ; Ben-Horin, Shomron ; Fiorino, Gionata. / The role of multimodal treatment in Crohn′s disease patients with perianal fistula : a multicentre retrospective cohort study. In: Alimentary Pharmacology and Therapeutics. 2018 ; Vol. 48, No. 9. pp. 941-950.
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abstract = "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.",
author = "Shaji Sebastian and Christopher Black and Daniela Pugliese and Alessandro Armuzzi and Kapil Sahnan and Elkady, {Soad M.} and Katsanos, {Kostas H.} and Christodoulou, {Demitrios K.} and Christian Selinger and Giovanni Maconi and Fearnhead, {Nicola S.} and Uri Kopylov and Yana Davidov and Bosca-Watts, {Marta M.} and Pierre Ellul and Martina Muscat and Konstantinos Karmiris and Hart, {Ailsa L.} and Silvio Danese and Shomron Ben-Horin and Gionata Fiorino",
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T1 - The role of multimodal treatment in Crohn′s disease patients with perianal fistula

T2 - a multicentre retrospective cohort study

AU - Sebastian, Shaji

AU - Black, Christopher

AU - Pugliese, Daniela

AU - Armuzzi, Alessandro

AU - Sahnan, Kapil

AU - Elkady, Soad M.

AU - Katsanos, Kostas H.

AU - Christodoulou, Demitrios K.

AU - Selinger, Christian

AU - Maconi, Giovanni

AU - Fearnhead, Nicola S.

AU - Kopylov, Uri

AU - Davidov, Yana

AU - Bosca-Watts, Marta M.

AU - Ellul, Pierre

AU - Muscat, Martina

AU - Karmiris, Konstantinos

AU - Hart, Ailsa L.

AU - Danese, Silvio

AU - Ben-Horin, Shomron

AU - Fiorino, Gionata

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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.

AB - 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.

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