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Poor Prognosis for Perianal Involvement in Crohn’s Disease in 12,904 Patient Study

PERIANAL Crohn’s disease (PCD) with a severe phenotype has been shown to be associated with poor outcomes despite growing use of immunomodulators and biologics.

These results come from a new, large study conducted in Jerusalem, Israel, led by Dan Turner, Doctor at Shaare Zedek Medical Center at the Hebrew University. According to the authors, the study, which reviewed data from 12,904 patients with Crohn’s disease, is the first population-based study to compare management and outcomes in severe versus non-severe PCD and the first to include non-adults.

“PCD is a strong predictor of complicated disease course and requires early intensified treatment, especially in severe perianal disease,” the authors explained. Onset of PCD can occur at any time, even before Crohn’s disease is diagnosed.

Data from an inception cohort dating from 2005 and providing 86,119 person-years of follow-up were reviewed by the authors and follow-up was completed until January 2019, with a median follow-up of 6.6 years. PCD was defined as ‘fistulising disease or abscess, although it can include fissures and skin tags’; fistulising disease was diagnosed in 1,530 (12%) patients, of which 574 (4%) had the severe phenotype.

Data analysis revealed that those with PCD had higher rates of hospitalisation, surgery, colon cancer, and steroid dependency. The risk of anorectal cancer was almost three-times higher in patients with PCD compared with those without perianal involvement. Perianal disease preceded a diagnosis of Crohn’s disease in 602 (39%) patients with PCD, and 165 patients (11%) developed the condition despite previous biologic treatment.

Disease outcomes included inflammatory bowel disease-related hospitalisations and surgeries, perianal surgeries, the need for at least two biologics from different classes, growth failure in children, steroid dependency, mortality, and post-diagnosis inflammatory bowel disease-related malignancies such as non-Hodgkin’s lymphoma, skin cancers, small and large bowel adenocarcinoma, anorectal cancer, cervical cancer, and cholangiocarcinoma.

Current guidelines recommend early biologic treatment in the case of fistulising perianal disease; however, previous studies have shown that PCD is associated with complicated disease course despite intensive management: “These results emphasise the importance of early optimisation of treatment in patients with PCD,” highlighted this large-scale study.