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The Impact of Setons on Perianal Fistula Outcomes in Patients With Crohn's Disease Treated With Anti-TNF Therapy: A Multicentre Study

delete2025-03-18
delete4
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OA
AI
J
Jeffrey D. McCurdy
J
Javeria Munir
S
Simon Parlow
G
Gagan Deep Singh Sambhi
J
Jacqueline Reid
R
Russell Yanofsky
T
Talal Alenezi
J
Joseph Meserve
K
Kuan‐Hung Yeh
B
Brenda Becker
Z
Zubin Lahijanian
A
Anas Hussam Eddin
R
Ranjeeta Mallick
T
Tim Ramsay
G
Greg Rosenfeld
A
Ali Bessissow
T
Talat Bessissow
V
Vipul Jairath
D
David H. Bruining
B
Blair Macdonald
S
Siddharth Singh
DOI：10.1111/apt.70081delete
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Abstract

Abstract

En 中文
Background and Aims: We aimed to assess the impact of setons on perianal fistula outcomes in patients with perianal fistulising Crohn's disease (PFCD) treated with anti-TNF therapy. Methods: We included patients treated with their first anti-TNF therapy for PFCD after undergoing a pelvic MRI between 2005 and 2022 from 6 North American centres. Our exposure was one or more setons at the time of anti-TNF therapy. Our primary outcome was major adverse fistula outcome (MAFO), a composite of repeat local surgical intervention, hospitalisation, or faecal diversion for PFCD, and our secondary outcome was fistula remission defined clinically. We used 1:1 cardinality matching and propensity score weighting to control for fistula severity based on centrally read MRIs, luminal characteristics, and concomitant therapies. Results: Our analysis included 221 patients: 81 with setons and 140 without setons. After cardinality matching, our cohorts were balanced (standardised difference < 0.1 for all covariates). Patients with setons had similar rates of MAFO (HR 1.23; 95% CI, 0.68-2.21) and fistula remission at 6 months (OR, 0.81; 95% CI, 0.41-1.59) and 12 months (OR, 0.63; 95% CI, 0.31-1.27) compared to patients without setons. Our results remained stable when analysed by propensity score weighting and in a sensitivity analysis of patients who underwent an exam under anaesthesia. In patients with abscesses, there were lower rates of MAFO (HR, 0.49; 95% CI, 0.19-1.25) but not statistically significant in patients with setons. Conclusions: In this multicentre, setons were not associated with improved fistula outcomes. Future prospective controlled studies are warranted.
Keywords:
comparative effectiveness
multidisciplinary care
perianal fistula
setons

Journal

A
Alimentary Pharmacology and Therapeutics
IF:
6.7
Papers:
1.1W
Citations:
2.4W

Organization

No organization information available