Treatment patterns and clinical outcomes of current treatment options for Crohn’s perianal fistulas: a US chart review study

Perianal fistulas are a common complication of Crohn’s disease (CD). The aim of this study was to assess care patterns and clinical outcomes of current treatments for Crohn’s perianal fistulas (CPF) in the USA to address evidence gaps in treatment patterns and standard of care across healthcare organizations treating CPF. A retrospective, multi-site, medical chart review was conducted in patients with CPF. Data on treatments and clinical outcomes were collected for at least 2 years after the index date (date of the most recent episode of symptoms for new, persistent, or recurrent CPF occurring between January 2016 and December 2018). In total, 227 eligible patients were included in at least one of three fistula cohorts: new ( n = 94), persistent ( n = 108), and recurrent ( n = 34). Mean (standard deviation) age was 48 (13.7) years, 51% were male, and 82% were White. After index (median follow-up 31.8 months), 67% of patients received medication for CPF/underlying CD, of whom 74% received biologics, and 60% of patients underwent surgery for CPF, of whom 51–62% underwent incision/drainage or a seton placement. After index, 11% of patients achieved clinical fistula remission, 42% experienced new perianal abscess formation, 32% underwent surgical reintervention, and 5% had post-surgical complications. At 2 years after index, 24% of fistulas that were previously closed or in remission were reported as relapsed. Despite multiple treatment options, high rates of CPF persistence, recurrence, and surgical reinterventions were observed, along with low rates of clinical remission, suggesting frequent treatment failure and/or lack of response to treatment among patients with CPF. These findings indicate an unmet need for effective management strategies to improve long-term healing in CPF.