Biologics & penetrating CD

March 11, 2024

Issue 06

Clinical Question

Do biologics differ in their impact on penetrating features of Crohn’s disease?

Editor’s Bottom Line

Anti-TNF therapy may be effective for both prevention and treatment of fistulizing Crohn’s disease.

Reference

McCurdy JD, Stwalley D, Olsen MA, et al. Comparative Effectiveness of Biologic Therapies in Preventing Penetrating Complications in Patients With Crohn’s Disease. Clin Gastroenterol Hepatol. 2024;22(2):377–85.e5; https://www.cghjournal.org/article

Synopsis

To determine the impact of various biologics on prevention of penetrating complications of Crohn’s disease (CD), researchers analyzed data from 40,693 adults with the illness included in a commercial administrative database between 2006 and 2020. All patients had received their first biologic—either an anti-tumor necrosis factor (anti-TNF) agent (93%), ustekinumab (3%), or vedolizumab (4%)—during this time and none had a history of penetrating disease at the time of initial treatment with a biologic or in the year prior. Patients were a median 39 years of age at the time of initial biologics treatment and 54% were female. The median follow-up in the three treatment groups was 1.3–1.9 years.

Luminal penetrating disease was defined in the presence of one or more International Classification of Diseases-9/10-CM diagnostic codes for intra-abdominal abscesses or intra-abdominal fistulae, while perianal penetrating disease was considered in the presence of a diagnostic code for perianal fistula/abscess or procedure codes for seton placement or fistula procedures. Weighted analyses accounted for age, sex, comorbidities, history of CD surgery and disease severity.

Findings showed that 5% of all patients developed luminal penetrating disease during follow-up, while 18% developed perianal penetrating disease. Weighted analyses found that, compared with vedolizumab, anti-TNF agents were 33% more protective against luminal penetrating disease (Hazard Ratio [HR]: 0.66; 95% Confidence Interval [CI], 0.55–0.78; p<0.0001) and 12% more protective against perianal penetrating (HR: 0.88; 95% CI, 0.80–0.96; p=0.0045). Compared with ustekinumab, anti-TNF agents were 63% more protective against luminal penetrating disease (HR: 0.37; 95% CI, 0.3–0.46; p<0.0001), but were not significantly more protective against perianal penetrating disease.

There were no significant differences in the risk of luminal or perianal penetrating disease between vedolizumab and ustekinumab.

Details

Study Design: Comparative cohort
Funding: The Foundation for Barnes-Jewish Hospital, Washington University Department of Medicine and National Institutes of Health/National Center for Advancing Translational Sciences.
Allocation: None
Setting: Multicenter
Level of Evidence: 2b