The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study

Shaji Sebastian*, Christopher Black, Daniela Pugliese, Alessandro Armuzzi, Kapil Sahnan, Soad M. Elkady, Kostas H. Katsanos, Demitrios K. Christodoulou, Christian Selinger, Giovanni Maconi, Nicola S. Fearnhead, Uri Kopylov, Yana Davidov, Marta M. Bosca-Watts, Pierre Ellul, Martina Muscat, Konstantinos Karmiris, Ailsa L. Hart, Silvio Danese, Shomron Ben-HorinGionata Fiorino

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background: Treatment paradigms for Crohn′s disease with perianal fistulae (CD-pAF) are evolving. Aims: To study the impact of multimodality treatment in CD-pAF on recurrence rates and the need for re-interventions and to identify predictive factors for these outcomes. Methods: This was a multinational multicentre retrospective cohort study. Multimodality approach was defined as using a combination of medical treatments (anti-TNFs ± immunomodulators ± antibiotics) along with surgical approach (examination under anaesthesia (EUA) ± seton drainage) at diagnosis of CD-pAF. Univariable and multivariable analyses were performed for variables indicative of the need for reintervention. Results: A total of 253 patients were included. 65% of patients received multimodality approach. Multimodality treatment resulted in complete fistula healing in 52% of patients. Re-intervention was needed in 27% of patients with simple and in 40.3% of those with complex fistula. On multivariable analysis multimodality treatment (OR: 0.35, 95% CI: 0.17-0.57, P = 0.001), seton removal (OR: 0.090, 95% CI: 0.027-0.30, P = 0.0001, therapy with infliximab (OR: 0.19, 95% CI: 0.06-0.64, P = 0.007), and therapy with adalimumab (OR: 0.12, "95% CI: 0.026-0.56, P = 0.007) were predictive of avoiding repeat surgery. Proctitis (OR: 3.76, 95% CI: 1.09-12.96, P = 0.03) was predictive of the need for radical surgery (proctectomy, diverting stoma) while multimodality treatment reduced the need for radical surgery (OR: 0.21, 95% CI: 0.05-0.81, P = 0.02). Conclusions: Multimodality treatment, anti-TNFs use, and removal of setons after multimodality treatment can result in improved outcomes in CD patients with perianal fistulae and reduce the need for repeat surgery and radical surgery.

Original languageEnglish
Pages (from-to)941-950
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Issue number9
StatePublished - Nov 2018


FundersFunder number
Abbvie Takeda Jannsen
Danileele Pugliese, Saud Elkady Katsanos KH
Takeda Jansen Medtronic
Tillots Pharma
Abbott Laboratories
Johnson and Johnson
Takeda Pharmaceutical Company
Merck Sharp and Dohme
Dr. Falk Pharma


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