A retrospective analysis shows that steroid-sparing therapy helps prevent perianal fistulizing complications by nearly 60%.
Steroid-sparing therapies may be an underutilized source in managing Crohn’s disease, as these therapies appear to significantly reduce the risk of perianal fistulizing complications in young patients.
“What I found most interesting about this study was not that using effective medicines to treat Crohn’s disease was associated with lower risk of fistulas but how big a difference they seem to make,” said Jeremy Adler, MD, MSc, pediatric gastroenterologist, director of the Pediatric IBD program at the University of Michigan and lead author of the analysis, in a press release.
Limiting severe complications With Preventive Care
The inflammation within the digestive tract of a patient with Crohn’s disease, particularly within the intestinal tract, can result in fistulas that penetrate the bowel wall. Perianal fistulizing complications are common in patients with Crohn’s disease, especially children. Approximately 15%–20% of patients with adult-onset Crohn’s disease have these complications, increasing to about 30% in patients with child-onset Crohn’s disease. Most commonly, these fistulas develop in the perianal area, which for some patients may include the vagina, labia or scrotum. These fistulas cause patients pain and potentially become debilitating. Perianal fistulas have the capacity to severely decrease a patient’s quality of life and can lead to long-term health consequences, such as risk of septic contamination of neighboring tissues. In addition, 70% of patients with perianal fistulizing complications require surgical intervention, which still does not provide permanent treatment. Between 8% to 19% of patients with this condition required permanent diverting ostomy as treatment for perianal fistulizing complications. As such, preventing perianal fistulizing complications before they occur is in the best interest of the patient with the chronic condition to improve their quality of life: Currently, however, the number of evidence-based strategies in steroid-sparing therapy to prevent these complications are limited.
Retrospective Analysis and Results
Dr. Adler and his team reviewed data from Optum’s Clinformatics Data Mart for their analysis. They gathered data from 2,214 patients between ages 5 and 24 who were diagnosed with Crohn’s disease from July 2001 through June 2016. Of those patients, 56% used steroid-sparing therapies. Within two years, 415 patients developed perianal fistulizing complications, but patients who received steroid-sparing treatment for their conditions were 59% less likely to develop the complications. Of those who developed complications, approximately 55% fewer patients underwent ostomy surgeries.
“This gives me hope that better treatment can improve outcomes, even if it can’t always prevent fistulas,” Dr. Adler stated in the press release.