Approach to Medical Therapy in Perianal Crohn's Disease

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2021 Jul 29

PMID 34321838

Citations 10

Authors

Abhinav Vasudevan

David H Bruining

Edward V Loftus Jr

William Faubion

Eric C Ehman

Laura Raffals

Affiliations

Soon will be listed here.

Abstract

Perianal Crohn's disease remains a challenging condition to treat and can have a substantial negative impact on quality of life. It often requires combined surgical and medical interventions. Anti-tumor necrosis factor (anti-TNF) therapy, including infliximab and adalimumab, remain preferred medical therapies for perianal Crohn's disease. Infliximab has been shown to be efficacious in improving fistula closure rates in randomized controlled trials. Clinicians can be faced with a number of questions relating to the optimal use of anti-TNF therapy in perianal Crohn's disease. Specific issues include evaluation for the presence of perianal sepsis, the treatment target of therapy, the ideal time to commence treatment, whether additional medical therapy should be used in conjunction with anti-TNF therapy, and the duration of treatment. This article will discuss key studies which can assist clinicians in addressing these matters when they are considering or have already commenced anti-TNF therapy for the treatment of perianal Crohn's disease. It will also discuss current evidence regarding the use of vedolizumab and ustekinumab in patients who are failing to achieve a response to anti-TNF therapy for perianal Crohn's disease. Lastly, new therapies such as local injection of mesenchymal stem cell therapy will be discussed.

Citing Articles

Perianal fistulizing Crohn's disease: Mechanisms and treatment options focusing on cellular therapy.

Bhatnagar P, Elhariri S, Burud I, Eid N World J Gastroenterol. 2025; 31(9):100221.

PMID: 40061590 PMC: 11886048. DOI: 10.3748/wjg.v31.i9.100221.

Predictive modeling to evaluate long-term treatment effectiveness of darvadstrocel in patients with complex perianal fistulas in Crohn's disease.

Karki C, Hantsbarger G, Turkstra E, Fenu E, Genenz K, Gilaberte I BMC Gastroenterol. 2024; 24(1):479.

PMID: 39736547 PMC: 11684150. DOI: 10.1186/s12876-024-03513-3.

Establishment of a surveillance program for anal cancer in Crohn's disease.

Kayano H, Okada K, Yamamoto S, Koyanagi K World J Gastroenterol. 2024; 30(45):4844-4849.

PMID: 39649548 PMC: 11606372. DOI: 10.3748/wjg.v30.i45.4844.

Clinical utility of multi-row spiral CT in diagnosing hepatic nodular lesions, gastric cancer, and Crohn's disease: a comprehensive meta-analysis.

Xu M, Chen Y, Liu D, Wang L, Wu M Am J Clin Exp Immunol. 2024; 13(4):165-176.

PMID: 39310125 PMC: 11411159. DOI: 10.62347/SREJ4505.

Real-World Long-Term Persistence and Surgical Procedure-Free Period Among Bio-naïve Patients with Crohn's Disease and Fistula Initiated on Ustekinumab.

Zhdanava M, Kachroo S, Boonmak P, Burbage S, Shah A, Lefebvre P Adv Ther. 2024; 41(10):3922-3933.

PMID: 39162983 DOI: 10.1007/s12325-024-02963-1.

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