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Management of perianal fistulas in Crohn’s disease: a 2021 update of the French National Society of Coloproctology consensus

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Abstract

Background

Since our last publication of algorithms for the management of perianal fistulas in patients with Crohn’s disease, researchers have proposed a treat to target strategy systematic combotherapy for anal lesions, and indications for stem cell injection. In the absence robust publications, the Société Nationale Française de Coloproctologie (French National Society of Coloproctology [SNFCP]) wished to establish a group consensus using the Delphi method.

Methods

From October 2020 to January 2021, a scientific committee and panel of gastroenterologists and surgeons established answers which were submitted to the members of the SNFCP during a national conference in November 2020. Three questions were clarified and reformulated, and then submitted during a third and final round of consultation of members of the SNFCP.

Results

The target was defined as being the response obtained in every domain (symptoms, physical and radiological evaluation) which could be considered satisfactory, without the need to intensify therapeutic management. By consensus, the time required for clinical evaluation of the efficacy of treatment was 6 months. A response on magnetic resonance imaging (MRI) should include the absence of a collection of 10 mm or more in size at 6 months, and a frank decrease or complete disappearance of hyperintensity in T1 and T2 sequences of the main tract at 12 months. Systematic association of an immunosuppressant with tumor necrosis factor inhibitors did not reach the consensus level for adalimumab (50%), but just did for infliximab (70%). The majority of the respondents considered failure of one, or even two lines of different biotherapies to be potential indications for injection of stem cells.

Conclusions

These findings reinforce the importance of composite targets including MRI evaluation, and underscore the need for precise timing of evaluation. Combotherapy is only recommended with infliximab. Injection of stem cells is a second- or third-line option.

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References

  1. Bouchard D, Pigot F, Staumont G, Siproudhis L, Abramowitz L, Benfredj P et al (2018) Management of anoperineal lesions in Crohn’s disease: a French National Society of Coloproctology national consensus. Tech Coloproctol 22:905–917

    Article  CAS  Google Scholar 

  2. Hommes D, Colombel JF, Emery P, Greco M, Sandborn WJ (2012) Changing Crohn’s disease management: need for new goals and indices to prevent disability and improve quality of life. J Crohns Colitis 6(Suppl2):S224–S234

    Article  Google Scholar 

  3. Irvine EJ (1995) Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index McMaster IBD Study Group. J Clin Gastroenterol 20:27–32

    Article  CAS  Google Scholar 

  4. Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA et al (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340:1398–1405

    Article  CAS  Google Scholar 

  5. Panés J, García-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC et al (2016) Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn’s disease: a phase 3 randomised double-blind controlled trial. Lancet 388:1281–1290

    Article  Google Scholar 

  6. Lichtenstein GR, Diamond RH, Wagner CL, Fasanmade AA, Olson AD, Marano CW et al (2009) Benefits and risks of immunomodulators and maintenance infliximab for IBD-subgroup analyses across four randomized trials. Alimentary Pharmacol Therap 30:210–226

    Article  CAS  Google Scholar 

  7. Bouguen G, Siproudhis L, Gizard E, Wallenhorst T, Billioud V, Bretagne JF et al (2013) Long-term outcome of perianal fistulizing Crohn’s disease treated with infliximab. Clin Gastroenterol Hepatol 11:975–981

    Article  CAS  Google Scholar 

  8. Kopylov U, Al-Taweel T, Yaghoobi M, Nauche B, Bitton A, Lakatos PL et al (2014) Adalimumab monotherapy versus combination therapy with immunomodulators in patients with Crohn’s disease: a systematic review and meta-analysis. J Crohns Colitis 8:1632–1641

    Article  Google Scholar 

  9. Colombel JF, Jharap B, Sandborn WJ, Feagan B, Peyrin-Biroulet L, Eichner SF et al (2017) Effects of concomitant immunomodulators on the pharmacokinetics, efficacy and safety of adalimumab in patients with Crohn’s disease or ulcerative colitis who had failed conventional therapy. Aliment Pharmacol Ther 45:50–62

    Article  CAS  Google Scholar 

  10. Molendijk I, Bonsing BA, Roelofs H, Peeters KC, Wasser MN, Dijkstra G et al (2015) Allogeneic bone marrow-derived mesenchymal stromal cells promote healing of refractory perianal fistulas in patients with Crohn’s disease. Gastroenterology 149:918–927

    Article  Google Scholar 

  11. Levesque BG, Sandborn WJ, Ruel J, Feagan BG, Sands BE, Colombel JF (2015) Converging goals of treatment of inflammatory bowel disease from clinical trials and practice. Gastroenterology 148:37–51

    Article  Google Scholar 

  12. Sahnan K, Tozer PJ, Adegbola SO, Lee MJ, Heywood N, McNair AGK et al (2019) Developing a core outcome set for fistulising perianal Crohn’s disease. Gut 68:226–238

    Article  Google Scholar 

  13. Malian A, Rivière P, Bouchard D, Pigot F, Eléouet-Kaplan M, Favreau-Weltzer C et al (2020) Predictors of perianal fistula relapse in Crohn’s disease. Inflamm Bowel Dis 26:926–931

    Article  Google Scholar 

  14. Kennedy NA, Heap GA, Green HD, Hamilton B, Bewshea C, Walker GJ et al (2019) UK Inflammatory Bowel Disease Pharmacogenetics Study Group. Predictors of anti-TNF treatment failure in anti-TNF-naive patients with active luminal Crohn’s disease: a prospective, multicentre, cohort study. Lancet Gastroenterol Hepatol 4:341–353

    Article  Google Scholar 

  15. Davidov Y, Ungar B, Bar-Yoseph H, Carter D, Haj-Natour O, Yavzori M et al (2017) Association of induction infliximab levels with clinical response in perianal Crohn’s disease. J Crohns Colitis 11:549–555

    PubMed  Google Scholar 

  16. Yarur AJ, Kanagala V, Stein DJ, Czul F, Quintero MA, Agrawal D et al (2017) Higher infliximab trough levels are associated with perianal fistula healing in patients with Crohn’s disease. Aliment Pharmacol Ther 45:933–940

    Article  CAS  Google Scholar 

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Acknowledgements

The members of the SNFCP and Members of the GETAID: Guillaume Bouguen (Digestive Diseases Unit, CHU Pontchaillou, 2 rue Henri Le Guilloux 35033 Rennes, France), David Laharie (Hepato-Gastroenterology Unit, CHU Haut Lévèque, 33600 Pessac ), Eddy Cotte (Digestive and Endocrine Surgery Unit, Hospital Lyon-Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite cedex ), Yves Panis (Digestive Surgery Unit, Beaujon Hospital, 100 boulevard du Général Leclerc, 92110 Clichy), L Peyrin-Biroulet (Hepato-Gastroenterology Unit, CHRU Nancy, 54511 Vandoeuvre les Nancy), Xavier Roblin (Gastroenterology, Hepatology and Inflammatory Bowel Diseases Unit, CHU Saint Etienne, 25 boulevard Pasteur, 42055 Saint-Etienne), Philippe Zerbib (Digestive Unit, Hospital Huriez, rue Michel Polonowski, 59037 Lille) as co-authors, Emmanuelle Babin-Pigot and Marie Ferry for essential logistic assistance.

Author information

Authors and Affiliations

  1. Proctology Unit, Bagatelle Hospital, 33400, Talence, France

    D. Bouchard, F. Pigot, D. Bouchard, F. Pigot & L. Tracanelli

  2. Hospital Paris Saint-Joseph, Medico-Surgical Proctology Unit, 185, rue Raymond Losserand, 75014, Paris, France

    V. de Parades & V. de Parades

  3. Clinique Croix du Sud, Maison de Consultation, BAL Fonsegrives, Quint-Fonsegrives, France

    G. Staumont, G. Staumont & N. Fathallah

  4. Proctology Unit, Bichat Hospital, Paris France and Ramsay, GDS Clinique Blomet, Paris, France

    L. Abramowitz & L. Abramowitz

  5. Digestive Diseases Unit, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France

    L. Siproudhis, L. Siproudhis & G. Bouguen

  6. Hepato-Gastroenterology Unit, CHU Haut Lévèque, 33600, Pessac, France

    D. Laharie

  7. Digestive and Endocrine Surgery Unit, Hospital Lyon-Sud, 165 chemin du grand Revoyet, 69495, Pierre Bénite cedex, France

    E. Cotte

  8. Digestive Surgery Unit, Beaujon Hospital, 100 boulevard du Général Leclerc, 92110, Clichy, France

    Y. Panis

  9. Hepato-Gastroenterology Unit, CHRU Nancy, 54511, Vandoeuvre les Nancy, France

    L. Peyrin-Biroulet

  10. Gastroenterology, Hepatology and Inflammatory Bowel Diseases Unit, CHU Saint Etienne, 25 boulevard Pasteur, 42055, Saint-Etienne, France

    X. Roblin

  11. Digestive Unit, Hospital Huriez, Rue Michel Polonowski, 59037, Lille, France

    P. Zerbib

Authors
  1. D. Bouchard
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  2. F. Pigot
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  3. V. de Parades
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  4. G. Staumont
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  5. L. Abramowitz
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  6. L. Siproudhis
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Consortia

Members of the SNFCP

  • D. Bouchard
  • , F. Pigot
  • , V. de Parades
  • , G. Staumont
  • , L. Abramowitz
  • , L. Siproudhis
  • , L. Tracanelli
  • , N. Fathallah
  • , E. Babin-Pigot
  •  & M. Ferry

Members of the GETAID

  • G. Bouguen
  • , D. Laharie
  • , E. Cotte
  • , Y. Panis
  • , L. Peyrin-Biroulet
  • , X. Roblin
  •  & P. Zerbib

Corresponding author

Correspondence to D. Bouchard.

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Conflict of interest

DB: Takeda as consultant, Abbvie Janssen Takeda for learning. LS: Takeda Abbvie Janssen MSD for clinical research, Takeda as consultant, Takeda Abbvie Janssen Amgen Ferring for learning. VdP: Takeda as consultant, Abbvie, Amgen, Tillots for learning. GS: Takeda, Janssen as consultant, Abbvie, Takeda for learning. LA: Abbvie, Takeda, Celltrion for clinical research, Takeda as consultant, Takeda, Abbvie, Janssen, Ferring for learning. FP: Abbvie, Takeda for learning.

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The Members of SNFCP and Members of GETAID were listed in Acknowledgement section.

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Bouchard, D., Pigot, F., de Parades, V. et al. Management of perianal fistulas in Crohn’s disease: a 2021 update of the French National Society of Coloproctology consensus. Tech Coloproctol 26, 805–811 (2022). https://doi.org/10.1007/s10151-022-02678-x

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