Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis
Background/Aims Perianal fistulas are a debilitating manifestation of Crohn’s disease (CD). Despite the advent of anti-tumor necrosis factor (anti-TNF) therapy, the medical management of fistulizing CD continues to be challenged by unmet needs. We conducted a systematic review and meta-analysis of t...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Association for the Study of Intestinal Diseases
2022-04-01
|
| Series: | Intestinal Research |
| Subjects: | |
| Online Access: | http://www.irjournal.org/upload/pdf/ir-2021-00091.pdf |
| _version_ | 1818194437118885888 |
|---|---|
| author | Fares Ayoub Matthew Odenwald Dejan Micic Sushila R. Dalal Joel Pekow Russell D. Cohen David T. Rubin Atsushi Sakuraba |
| author_facet | Fares Ayoub Matthew Odenwald Dejan Micic Sushila R. Dalal Joel Pekow Russell D. Cohen David T. Rubin Atsushi Sakuraba |
| author_sort | Fares Ayoub |
| collection | DOAJ |
| description | Background/Aims Perianal fistulas are a debilitating manifestation of Crohn’s disease (CD). Despite the advent of anti-tumor necrosis factor (anti-TNF) therapy, the medical management of fistulizing CD continues to be challenged by unmet needs. We conducted a systematic review and meta-analysis of the effectiveness of vedolizumab for the management of perianal fistulizing CD. Methods A search of PubMed, EMBASE and the Cochrane Library was performed from inception to June 2020 for studies reporting rates of perianal fistula healing in CD patients treated with vedolizumab. The primary outcome of interest was complete healing of perianal fistulas and the secondary outcome was partial healing. The pooled fistula healing rates with 95% confidence intervals (CI) were calculated utilizing a random effects model. Results A total of 74 studies were initially identified, 4 of which met the inclusion criteria. A total of 198 patients with active perianal fistulas were included, 87% of whom had failed previous anti-TNF therapy. The pooled complete healing rate was 27.6% (95% CI, 18.9%–37.3%) with moderate heterogeneity (I2=49.4%) and the pooled partial healing rate was 34.9% (95% CI, 23.2%–47.7%) with high heterogeneity (I2=67.1%). Conclusions In a meta-analysis of 4 studies that included 198 patients with perianal fistulizing CD, the majority of whom had failed previous anti-TNF therapy, vedolizumab treatment led to healing of perianal fistulas in nearly one-third of the patients. The lack of high-quality data and significant study heterogeneity underscores the need for future prospective studies of fistula healing in patients receiving anti-integrin therapy. |
| first_indexed | 2024-12-12T01:02:16Z |
| format | Article |
| id | doaj.art-fa735fe1a21c49d4a6bd6f20c307f003 |
| institution | Directory Open Access Journal |
| issn | 1598-9100 2288-1956 |
| language | English |
| last_indexed | 2024-12-12T01:02:16Z |
| publishDate | 2022-04-01 |
| publisher | Korean Association for the Study of Intestinal Diseases |
| record_format | Article |
| series | Intestinal Research |
| spelling | doaj.art-fa735fe1a21c49d4a6bd6f20c307f0032022-12-22T00:43:41ZengKorean Association for the Study of Intestinal DiseasesIntestinal Research1598-91002288-19562022-04-0120224025010.5217/ir.2021.00091940Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysisFares Ayoub0Matthew Odenwald1Dejan Micic2Sushila R. Dalal3Joel Pekow4Russell D. Cohen5David T. Rubin6Atsushi Sakuraba7 Inflammatory Bowel Disease Center, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA Inflammatory Bowel Disease Center, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA Inflammatory Bowel Disease Center, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA Inflammatory Bowel Disease Center, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA Inflammatory Bowel Disease Center, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA Inflammatory Bowel Disease Center, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA Inflammatory Bowel Disease Center, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA Inflammatory Bowel Disease Center, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USABackground/Aims Perianal fistulas are a debilitating manifestation of Crohn’s disease (CD). Despite the advent of anti-tumor necrosis factor (anti-TNF) therapy, the medical management of fistulizing CD continues to be challenged by unmet needs. We conducted a systematic review and meta-analysis of the effectiveness of vedolizumab for the management of perianal fistulizing CD. Methods A search of PubMed, EMBASE and the Cochrane Library was performed from inception to June 2020 for studies reporting rates of perianal fistula healing in CD patients treated with vedolizumab. The primary outcome of interest was complete healing of perianal fistulas and the secondary outcome was partial healing. The pooled fistula healing rates with 95% confidence intervals (CI) were calculated utilizing a random effects model. Results A total of 74 studies were initially identified, 4 of which met the inclusion criteria. A total of 198 patients with active perianal fistulas were included, 87% of whom had failed previous anti-TNF therapy. The pooled complete healing rate was 27.6% (95% CI, 18.9%–37.3%) with moderate heterogeneity (I2=49.4%) and the pooled partial healing rate was 34.9% (95% CI, 23.2%–47.7%) with high heterogeneity (I2=67.1%). Conclusions In a meta-analysis of 4 studies that included 198 patients with perianal fistulizing CD, the majority of whom had failed previous anti-TNF therapy, vedolizumab treatment led to healing of perianal fistulas in nearly one-third of the patients. The lack of high-quality data and significant study heterogeneity underscores the need for future prospective studies of fistula healing in patients receiving anti-integrin therapy.http://www.irjournal.org/upload/pdf/ir-2021-00091.pdfvedolizumabperianal fistulaperianal diseasecrohn diseasemeta-analysis |
| spellingShingle | Fares Ayoub Matthew Odenwald Dejan Micic Sushila R. Dalal Joel Pekow Russell D. Cohen David T. Rubin Atsushi Sakuraba Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis Intestinal Research vedolizumab perianal fistula perianal disease crohn disease meta-analysis |
| title | Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis |
| title_full | Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis |
| title_fullStr | Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis |
| title_full_unstemmed | Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis |
| title_short | Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis |
| title_sort | vedolizumab for perianal fistulizing crohn s disease systematic review and meta analysis |
| topic | vedolizumab perianal fistula perianal disease crohn disease meta-analysis |
| url | http://www.irjournal.org/upload/pdf/ir-2021-00091.pdf |
| work_keys_str_mv | AT faresayoub vedolizumabforperianalfistulizingcrohnsdiseasesystematicreviewandmetaanalysis AT matthewodenwald vedolizumabforperianalfistulizingcrohnsdiseasesystematicreviewandmetaanalysis AT dejanmicic vedolizumabforperianalfistulizingcrohnsdiseasesystematicreviewandmetaanalysis AT sushilardalal vedolizumabforperianalfistulizingcrohnsdiseasesystematicreviewandmetaanalysis AT joelpekow vedolizumabforperianalfistulizingcrohnsdiseasesystematicreviewandmetaanalysis AT russelldcohen vedolizumabforperianalfistulizingcrohnsdiseasesystematicreviewandmetaanalysis AT davidtrubin vedolizumabforperianalfistulizingcrohnsdiseasesystematicreviewandmetaanalysis AT atsushisakuraba vedolizumabforperianalfistulizingcrohnsdiseasesystematicreviewandmetaanalysis |