Gastroenterology ·
Crohn’s cohort links TNF antagonists and ustekinumab to fewer perianal complications
A retrospective claims-based cohort study included 10,482 adults with non-penetrating Crohn’s disease who initiated advanced therapy. TNF antagonists and ustekinumab were associated with lower risks of perianal penetrating complications than vedolizumab during follow-up.
- 10,482 adults with non-penetrating Crohn’s disease were studied.
- Perianal complications occurred in 3.4% during follow-up.
- TNF antagonists and ustekinumab had lower adjusted risk than vedolizumab.
- Retrospective claims data cannot establish causality.
Researchers used the OptumLabs Data Warehouse to identify adults with Crohn’s disease who started a TNF antagonist, vedolizumab, ustekinumab, an IL-23p19 antagonist or a JAK inhibitor between 2016 and 2022. Patients with a Crohn’s-related penetrating complication at baseline or within three months after treatment initiation were excluded. The retrospective cohort included 10,482 patients, with a mean follow-up of 18.5 months; 360 patients (3.4%) developed a perianal penetrating complication.
After adjustment using propensity score-based weighting, TNF antagonists (hazard ratio [HR] 0.56, 95% CI 0.42–0.74) and ustekinumab (HR 0.62, 95% CI 0.46–0.83) were associated with lower risk than vedolizumab. Similar associations were reported among therapy-naive patients and those with prior advanced-therapy exposure. The abstract does not report a significant comparative finding for IL-23p19 antagonists or JAK inhibitors.
The findings may inform treatment discussions for patients with non-penetrating disease, but they do not establish that one therapy causes fewer complications. This was an observational analysis of administrative claims, so residual confounding and limits in claims-based outcome ascertainment remain important considerations.
In practice
For adults with non-penetrating Crohn’s disease starting advanced therapy, this cohort found lower adjusted risks of perianal penetrating complications with TNF antagonists and ustekinumab than with vedolizumab. The results may be relevant when discussing therapy selection, including in therapy-naive and previously treated patients. However, the study was retrospective and based on administrative claims; the associations do not show that treatment choice caused the difference and do not by themselves justify changing practice.
AI-generated clinical interpretation · Not editor-reviewed
Is this summary clinically accurate?
Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.
Sign in to rate this summary →Source
Journal of Crohn's and Colitis: Risk of perianal penetrating complications among adult patients with non-penetrating Crohn’s disease initiating advanced therapies: a retrospective cohort study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.