Early Anti-TNFα Therapy Cuts Perianal Fistula Complications in Pediatric Crohn Disease
FRIDAY, Jan. 3, 2025 -- For pediatric patients with Crohn disease, early anti-tumor necrosis factor-alpha (anti-TNFα) therapy is beneficial in preventing the development of perianal fistula complications (PFCs), according to a study published online Dec. 12 in Gut.
Jeremy Adler, M.D., from the University of Michigan in Ann Arbor, and colleagues examined whether early anti-TNFα therapy prevents PFCs in pediatric patients with Crohn disease. Participants had never experienced PFCs 30 days after study enrollment. Nearest-neighbor propensity score-matched triad analyses were conducted. A total of 447 matched patients without perianal fistula were included in the study.
The researchers observed a significant association for the presence of nonpenetrating perianal lesions (large skin tags, ulcers, and/or fissures) with PFC development (odds ratio, 4.08). The odds of PFCs were significantly reduced in association with early anti-TNFα therapy (odds ratio, 0.18). Among patients with perianal lesions, the odds of PFC development were further reduced in association with anti-TNFα therapy (odds ratio, 0.055). A reduced risk for PFCs was not seen in association with any other treatment group.
"Based on these findings, which corroborate prior studies, early anti-TNFα therapy should be recommended for pediatric patients at increased risk in order to prevent PFCs, serious complications, which are difficult to treat," the authors write. "The specific timing of how early anti-TNFα therapy should be introduced for different patient populations requires further study."
One author disclosed receipt of consulting fees from Janssen Research & Development.
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