Adler Jeremy, Gadepalli Samir, Rahman Moshiur, Kim Sandra
Pediatric Gastroenterology, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA.
Gut. 2025 Mar 6;74(4):539-546. doi: 10.1136/gutjnl-2024-333280.
One in three children with Crohn's disease develop perianal fistula complications (PFCs), among the most disturbing and difficult-to-treat disease-related complications. Retrospective evidence suggests PFCs may be preventable.
We aimed to determine if early antitumour necrosis factor-alpha (anti-TNF⍺) therapy prevents PFC development in a well-characterised prospective cohort of paediatric patients with Crohn's disease who were free from PFC at enrolment.
RISK was a multicentre inception cohort of children newly diagnosed with Crohn's disease. We included all patients who had never experienced PFCs 30 days after study enrolment. We conducted nearest-neighbour propensity score-matched triad analyses. Matching was performed to balance patient characteristics across three mutually exclusive treatment groups based on therapy prior to either PFC development or the end of the observation period.
Among 873 patients without perianal fistula, 447 matched patients were included (149 per treatment group). The presence of non-penetrating perianal lesions (large skin tags, ulcers and/or fissures) was significantly associated with PFC development, with 4-fold greater odds of PFC (OR 4.08, 95% CI (95% CI) 1.70 to 9.78; p=0.0016). Early anti-TNF⍺ therapy was associated with an 82% decrease in the odds of PFC (OR 0.18, 95% CI 0.05 to 0.66; p=0.01). Among those with perianal lesions, anti-TNF⍺ therapy was associated with 94% reduced odds of PFC development (OR 0.055, 95% CI 0.006 to 0.50; p=0.010). No other treatment group was associated with reduced risk of PFC.
Early anti-TNF therapy prevents perianal fistula development, especially among patients at increased risk.
三分之一的克罗恩病患儿会出现肛周瘘管并发症（PFCs），这是最令人困扰且最难治疗的疾病相关并发症之一。回顾性证据表明PFCs可能是可预防的。
我们旨在确定早期抗肿瘤坏死因子-α（抗TNFα）治疗能否预防在入组时无PFC的、特征明确的儿科克罗恩病前瞻性队列中PFC的发生。
RISK是一个新诊断为克罗恩病儿童的多中心起始队列。我们纳入了在研究入组30天后从未经历过PFCs的所有患者。我们进行了最近邻倾向评分匹配三联分析。基于PFC发生前或观察期结束前的治疗情况，进行匹配以平衡三个相互排斥治疗组的患者特征。
在873例无肛周瘘管的患者中，纳入了447例匹配患者（每个治疗组149例）。非穿透性肛周病变（大的皮赘、溃疡和/或肛裂）的存在与PFC的发生显著相关，PFC的发生几率高4倍（OR 4.08，95%CI（95%CI）1.70至9.78；p = 0.0016）。早期抗TNFα治疗与PFC发生几率降低82%相关（OR 0.18，95%CI 0.05至0.66；p = 0.01）。在有肛周病变的患者中，抗TNFα治疗与PFC发生几率降低94%相关（OR 0.055，95%CI 0.006至0.50；p = 0.010）。没有其他治疗组与PFC风险降低相关。
早期抗TNF治疗可预防肛周瘘管的发生，尤其是在风险增加的患者中。
