The following is a summary of “Long-Term Outcomes of Biological Therapy in Crohn’s Disease Complicated With Internal Fistulizing Disease: BIOSCOPE Study From GETECCU,” published in the June 2023 issue of Gastroenterology by Acosta, et al.

The prevalence of penetrating complications in Crohn’s disease (CD), such as internal fistulizing disease, increases over time. However, limited evidence exists regarding the medical treatment of this condition. For a study, researchers sought to evaluate the effectiveness of biologic agents in managing CD complicated with the internal fistulizing disease.

The study included adult patients with CD-related fistulae who received at least one biological agent for this condition. Patients receiving biologics for perianal disease, enterocutaneous, rectovaginal, anastomotic, or peristomal fistulae were excluded. The primary outcome measure was fistula-related surgery. Predictive factors associated with surgery and fistula closure were assessed using multivariate logistic regression and survival analyses.

A total of 760 patients from 53 hospitals were included in the study. Among them, 673 received anti-tumor necrosis factors, 69 received ustekinumab, and 18 received vedolizumab. After a median follow-up of 56 months, 240 patients required surgery, resulting in surgery rates of 32% for anti-tumor necrosis factor therapy, 41% for vedolizumab, and 24% for ustekinumab. Fistula closure was observed in 24% of patients. Older age, ileocolonic disease, entero-urinary fistulae, or an intestinal stricture distal to the fistula origin were associated with a higher risk of surgery. Nonsmokers and combination therapy with an immunomodulator were associated with a reduced risk of surgery.

Approximately three-quarters of patients with fistulizing CD benefited from biologic therapy, with 24% achieving fistula closure. However, approximately one-third of patients still require surgery due to refractory disease. Specific patient- and lesion-related factors can help identify individuals who are more likely to benefit from these drugs.

Source: journals.lww.com/ajg/Fulltext/2023/06000/Long_Term_Outcomes_of_Biological_Therapy_in.24.aspx