Surgical closure plus anti-TNF outperforms anti-TNF alone for perianal fistula

Anti-TNF treatment plus surgical closure resulted in radiological healing more frequently than anti-TNF treatment alone in Crohn’s disease (CD) patients with perianal fistula. In addition, no recurrences were observed in patients with radiological healing. According to the authors of this trial, surgical closure is therefore the superior treatment option in CD patients with perianal fistula.

A patient-preference, randomised controlled trial assessed the radiological healing 18 months after anti-TNF (n=56) or anti-TNF plus surgical closure (n=38) in CD patients with high perianal fistulas with a single internal opening [1]. Radiological healing was defined as a complete fibrotic fistula observed on MRI or a magnetic resonance novel index for fistula imaging in CD (MAGNIFI-CD) score ≤5. Ms Elise Meima-van Praag (Amsterdam University Medical Centre, the Netherlands) presented the findings of the study.

In the intention-to-treat analysis, patients in the surgical closure arm demonstrated a higher rate of radiological healing than patients in the anti-TNF arm (42.1% vs 12.5%; P<0.001). Clinical closure rates were not significantly different between the surgical closure arm (68%) and the anti-TNF arm (52%) in the intention-to-treat analysis. However, in the per-protocol analysis, the difference in clinical closure between the 2 treatment arms was significant, favouring the surgical closure arm. Furthermore, the median Perianal Disease Activity Index (PDAI) scores were significantly lower in the surgical closure arm at 18 months of follow up. The occurrence of re-intervention was not significantly different between the 2 treatment arms (surgical closure 13% vs anti-TNF 29%). Recurrence rates were similar for the 2 treatment arms. Importantly, patients with observed radiological healing did not have recurrences.

1. Meima-van Praag E, et al. Treatment of perianal fistulas in Crohn’s disease: anti-TNF with surgical closure versus anti-TNF alone (PISA-II), a patient preference RCT. OP18, ECCO 2021 Virtual Congress, 2-3 & 8-10 July.

 

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Posted on 2 July, 20218 April, 2024