Perianal Fistulizing Complications Preventable in Crohn Disease

Steroid-sparing therapy may reduce risk for PFCs in young patients with Crohn disease

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TUESDAY, June 16, 2020 (HealthDay News) -- For young patients with Crohn disease (CD), use of steroid-sparing therapy (SST) is associated with a reduced risk for perianal fistulizing complications (PFCs), according to a study published online June 9 in JAMA Network Open.

Jeremy Adler, M.D., from the University of Michigan in Ann Arbor, and colleagues examined the effectiveness of medical therapy for reducing the risk for PFCs among young people with CD in a comparative effectiveness analysis. Patients aged 5 to 24 years with CD, without PFCs, were identified from a database of U.S. commercial administrative claims; those who initiated SSTs were matched via propensity score to those who did not initiate SSTs (972 patients in each group).

The researchers found that within two years of the index date, 19.8 percent of patients developed PFCs. Compared with no SST use, SST use was associated with a reduced risk for PFC development in two years (hazard ratio, 0.41). Of those who developed PFCs, ostomy was performed in 55 percent fewer SST users versus nonusers. Compared with no SST use, use of immunomodulators alone, anti-tumor necrosis factor α alone, and combination therapy were associated with reduced risks for two-year PFC development (hazard ratios, 0.48, 0.53, and 0.17, respectively).

"Our research supports efforts to provide the best known therapy as early as possible to improve chances of altering disease course and preventing complications," Adler said in a statement.

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