Biological immunomodulators improve the healing rate in surgically treated perianal Crohn's fistulas

Aim The role of biological therapy in perianal fistulas associated with Crohns disease (CD) is uncertain as available data are confused and conflicting. In order to provide some clarity to the issue we have examined a large cohort of patients with perianal fistulas and CD and stratified them according to use of biological agents. Method Patients with perianal Crohns fistulas treated between June 1999 and June 2009 were stratified according to use of biological agents and outcome was examined. Healing was defined as absence of fistula or drainage. Prior to surgery perianal sepsis was eradicated with drains or setons. Endpoints were defined as either complete healing, improvement (minimal symptoms and drainage) or unhealed, as noted at subsequent outpatient follow-up. Variables assessed were age, body mass index, smoking, perineal involvement with Crohns granuloma and type of procedure. Fishers exact test and ?2 test were used for analysis. Results Two hundred and eighteen patients had anal fistulas and CD. Mean follow-up was 3.2 +/- 3 years with mean age 38.8 +/- 12.2 years and body mass index of 25.3 +/- 6. One hundred and seventeen patients (53.7%) underwent surgery alone (Group A) and 101 patients (46.3%) underwent surgery and biological immunomodulator treatments (Group B). Demographic data and CD history were similar between groups. Surgeries included seton drainge (n = 90), fistulotomy (n = 22), rectal advancement flap (n = 39), fistulotomy plus seton (n = 47) and others (n = 20). Overall improvement in Group A was in 42 patients (35.9%) vs 72 patients (71.3%) in Group B (P = 0.001). There was no significant difference in other studied variables between both groups. Conclusions There is a definite role for biological therapy as an adjuvant to surgery in patients with perianal fistulas and CD.