MDNews - Long Island

BY HILLARY EAMES A RE TROSPECTIVE ANALYSIS SHOWS THAT STEROIDSPARING THER APY HELPS PRE VENT PERIANAL FISTULIZING COMPLICATIONS BY NE ARLY 60%. STEROIDSPA RING THER A PIE S M AY be an underutilized source in managing Crohn's disease, as these therapies appear to signifi cantly reduce the risk of perianal fi stulizing complications in young patients. "What I found most interesting about this study was not that using e• ective medicines to treat Crohn's disease was associated with lower risk of fi stulas but how big a di• erence they seem to make," said Jeremy Adler, MD, MSc, pediatric gastroenterolo- gist, director of the Pediatric IBD program at the University of Michigan and lead author of the analysis, in a press release. LIMITING SEVERE COMPLICATIONS WITH PREVENTIVE CARE The infl ammation within the digestive tract of a patient with Crohn's disease, particularly within the intestinal tract, can result in fi stulas that penetrate the bowel wall. Perianal fi stulizing complications are common in patients with Crohn's disease, especially children. Approximately 15%–20% of patients with adult-onset Crohn's disease have these complications, increasing to about 30% in patients with child-onset Crohn's disease. Most commonly, these fi stulas develop in the perianal area, which for some patients may include the vagina, labia or scrotum. These fistulas cause patients pain and potentially become debilitating. Perianal fi stulas have the capacity to severely decrease a patient's quality of life and can lead to long-term health consequences, such as risk of septic contamination of neighboring tissues. In addition, 70% of patients with perianal fi stulizing complications require surgical intervention, which still does not provide permanent treatment. Between 8% to 19% of patients with this condition required permanent diverting ostomy as treatment for perianal fi stulizing complications. As such, preventing perianal fi stulizing complications before they occur is in the best interest of the patient with the chronic condition to improve their quality of life. Currently, however, the number of evidence-based strategies in steroid-sparing therapy to prevent these complications are limited. RETROSPECTIVE ANALYSIS AND RESULTS D r. A d ler a nd h i s t e a m r e v ie we d d a t a f r om O p t u m's Clinformatics Data Mart for their analysis. They gathered data from 2,214 patients between ages 5 and 24 who were diagnosed with Crohn's disease from July 2001 through June 2016. Of those patients, 56% used steroid-sparing therapies. Within two years, 415 patients developed perianal fi stulizing complications, but patients who received steroid-sparing treatment for their conditions were 59% less likely to develop the complications. Of those who developed complications, approximately 55% fewer patients underwent ostomy surgeries. "This gives me hope that better treatment can improve out- comes, even if it can't always prevent fi stulas," Dr. Adler stated in the press release. n STEROID-SPARING THERAPY SHOWN TO REDUCE RISK OF CROHN'S DISEASE COMPLICATIONS 1 0

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