Division of Gastroenterology and Hepatology.
Division of Pediatric Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA.
J Clin Gastroenterol. 2023 Jul 1;57(6):617-623. doi: 10.1097/MCG.0000000000001729.
Perianal Crohn's disease (pCD) represents an aggressive phenotype with limited studies on long-term outcomes. We evaluated 5-year outcomes of these patients on biologic therapies.
We performed a retrospective analysis of patients with pCD at a tertiary medical center. We used Kaplan-Meier curves to estimate rates and multivariate logistic regression to identify predictors of long-term outcomes.
We included 311 patients with pCD of which 168 patients were started on biologics [138 anti-tumor necrosis factor (TNF) α, 14 vedolizumab, 16 ustekinumab] at the time of diagnosis. Anti-TNF use at the time of diagnosis was associated with decreased rates of perianal abscess recurrence [hazard ratio (HR)=0.48, 95% confidence interval (CI): 0.32-0.74], whereas ustekinumab use was associated with increased rates of perianal fistula closure (HR=3.58, 95% CI: 1.04-12.35) and decreased rates of perianal abscess recurrence (HR=0.20, 95% CI: 0.07-0.56) at follow-up. Among patients who failed their first anti-TNF, switching to another anti-TNF was associated with decreased rates of colectomy (HR=0.20, 95% CI: 0.04-0.90) and permanent diversion (HR=0.16, 95% CI: 0.03-0.94) compared with ustekinumab, whereas vedolizumab use was associated with decreased perianal fistula closure (HR=0.22, 95% CI: 0.05-0.96) compared with ustekinumab. Predictors of colectomy included colonic disease (odds ratio=2.71, 95% CI: 1.36-5.38) and anal stenosis (odds ratio=4.44, 95% CI: 1.59-12.43).
Type of biologic use at the time of pCD diagnosis or after first anti-TNF failure may be associated with long-term outcomes in patients with pCD.
肛周克罗恩病（pCD）代表一种侵袭性表型，其长期结局的研究有限。我们评估了接受生物治疗的这些患者的 5 年结局。
我们对一家三级医疗中心的 pCD 患者进行了回顾性分析。我们使用 Kaplan-Meier 曲线估计了这些患者的长期结局，并采用多变量逻辑回归分析来识别这些结局的预测因素。
我们纳入了 311 例 pCD 患者，其中 168 例患者在诊断时开始接受生物制剂治疗[138 例抗 TNF-α，14 例 vedolizumab，16 例 ustekinumab]。诊断时使用抗 TNF-α与降低肛周脓肿复发率相关（风险比 [HR]=0.48，95%置信区间 [CI]：0.32-0.74），而 ustekinumab 与增加肛周瘘管闭合率相关（HR=3.58，95% CI：1.04-12.35），降低肛周脓肿复发率（HR=0.20，95% CI：0.07-0.56）。在首次抗 TNF-α治疗失败的患者中，与 ustekinumab 相比，换用另一种抗 TNF-α治疗与降低结直肠切除术（HR=0.20，95% CI：0.04-0.90）和永久性转流术（HR=0.16，95% CI：0.03-0.94）的发生率相关，而与 ustekinumab 相比，vedolizumab 与降低肛周瘘管闭合率相关（HR=0.22，95% CI：0.05-0.96）。结直肠切除术的预测因素包括结肠疾病（比值比=2.71，95% CI：1.36-5.38）和肛门狭窄（比值比=4.44，95% CI：1.59-12.43）。
pCD 诊断时或首次抗 TNF-α治疗失败后生物制剂的使用类型可能与 pCD 患者的长期结局相关。
