Biologics and small molecules for perianal Crohn's disease: a systematic review and meta-analyses of randomized placebo-controlled trials.
Yuhong Yuan, Vipul Jairath, Jurij Hanzel et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis pooled placebo-controlled randomized trials of advanced therapies for perianal fistulizing Crohn’s disease. Fourteen studies were included, but only four were designed specifically for this condition; the others were post hoc analyses of luminal Crohn’s disease trials. During induction, therapies increased fistula response (RR 1.65, 95% CI 1.22-2.22) and remission (RR 1.91, 95% CI 1.37-2.67) versus placebo. Maintenance outcomes also favored treatment. Infliximab showed benefit across phases, while evidence for other agents was more limited.
Key findings
- Across induction trials, advanced therapies improved fistula response versus placebo (RR 1.65, 95% CI 1.22-2.22).
- Induction fistula remission favored advanced therapies (RR 1.91, 95% CI 1.37-2.67).
- During maintenance, advanced therapies favored fistula response (RR 1.54, 95% CI 1.21-1.97) and remission (RR 2.08, 95% CI 1.49-2.90).
- Infliximab showed significant benefit across reported response and remission outcomes; evidence for adalimumab, ustekinumab, and upadacitinib was limited.
Why it matters
Perianal fistulizing disease is a distinct treatment challenge, and evidence from trials of luminal Crohn’s disease may not fully establish efficacy for fistulas. This synthesis indicates that advanced therapies can improve fistula outcomes compared with placebo, while also showing that the evidence base is uneven. The distinction matters when interpreting treatment effects and considering how confidently findings apply to this population.
What to keep in mind
Only four of the 14 included trials were designed specifically for perianal disease; the remaining post hoc analyses had moderate to serious risk of bias.