What Researchers Did
Researchers systematically reviewed the role of immunosuppressants in managing complex perianal Crohn's disease.
What They Found
Azathioprine responders showed a reduced risk of perianal surgery (OR = 0.36; 95% CI: 0.27-0.46), and early administration of azathioprine increased the proportion of patients free of perianal surgery. Complex perianal fistulising Crohn's disease typically requires combination therapy with anti-TNF and azathioprine, as corticosteroids are not effective.
What This Means for Canadian Patients
Canadian patients with complex perianal Crohn's disease should discuss early, combined medical-surgical treatment options, including immunosuppressants and anti-TNF therapy, with their healthcare providers. For those aged 40 or older with recent perianal disease without fistulae, azathioprine monotherapy may be considered, though response can be slow.
Canadian Relevance
This systematic review has Canadian relevance due to the involvement of a Canadian author, contributing to the global understanding of perianal Crohn's disease management.
Study Limitations
The review highlights that the role of certain emerging therapies, such as adipose-derived stem cell injection, requires further long-term studies, indicating a limitation in the current evidence base.