What question did this study set out to answer?

This research aims to assess the long-term effectiveness of anti-TNF agents in treating perianal fistulas without luminal Crohn’s disease.

January 23, 2026

P0955Efficacy of Anti-TNF Agents for the Treatment of Anoperineal Fistulas Without Luminal Crohn’s Disease: A Multicenter Cohort Study.

Key Points

This research aims to assess the long-term effectiveness of anti-TNF agents in treating perianal fistulas without luminal Crohn’s disease.
Retrospective cohort study including patients treated with anti-TNF agents from 2006 to 2024.
Patients had recurrent perianal fistulas without evidence of luminal Crohn’s disease.
Clinical outcomes assessed were remission, response rates, and MRI findings.
At 12 months, clinical response achieved in 51% of patients; remission in 25%.
At 36 months, response rates fell to 29% and remission to 21%.
MRI response was 52.3% at 12 months, dropping to 21% at 36 months.

Abstract

Abstract Background Isolated perianal Crohn’s Disease (CD) represent a diagnostic and therapeutic challenge. Evidence on the efficacy of anti-TNF agents in this context remains limited (1). The aim of this study was to evaluate the long-term effectiveness of anti-TNF among patients with perianal fistula without luminal CD. Methods All consecutive patients (i) with recurrent perianal fistulas, (ii) without evidence of luminal CD after upper endoscopy and ileocolonoscopy, and (iii) treated with anti-TNF (infliximab or adalimumab) in 10 French centers between January 2006 and December 2024 were included in this retrospective cohort. The TOPCLASS classification was used to characterize the type of perianal involvement (1). Clinical remission (disappearance of discharge and fistula openings), clinical response (decrease in fistula discharge according to the clinician), and MRI response/remission were evaluated. Discontinuation of anti-TNF therapy for reasons other than clinical remission, the need of antibiotic therapy, or for further anoperineal surgery were considered treatment failures. Results Sixty-five patients were included (median age 37 years IQR: 28-44), 37 (57%) men and 20 (33%) active smokers). All had undergone at least one perianal surgery prior to anti-TNF treatment (median number of procedures: 3 2-4). Almost all fistula tracts were complex (97%). According to the TOPCLASS consensus criteria (1), 26 patients (39%) met the definition of isolated anal CD. The median follow-up was 28 months 12-60 and the median duration of exposure to anti-TNF agent was 19 12-36 months. At 12 and 36 months, clinical response was achieved in 32/63 (51%) and 10/35 (29%) patients, respectively, while clinical remission was achieved in 16/63 (25%) and 7/34 (21%) patients (Figure 1). At 12 months, MRI response was observed in 29/55 (52, 3%) patients and remission in 6/55 (11%) patients. At 36 months, MRI response rate was 7/21 (21%) and the remission rate was 1/21 (5%). In univariate analysis, transsphincteric tracts and rectovaginal fistulae were the only caracteristics associated with clinical remission at 12 months (respective odds radios: 3. 6 (1. 1 – 11. 8) ; p = 0. 03 and 11. 5 (1. 5-151. 2) ; p = 0. 04). During follow-up, 21 of the 53 patients who had a seton in place at baseline (83% of the cohort, 53/65) underwent seton removal (39. 3%). In addition, luminal CD were diagnosed in 10 patients (15%), including 4 who had met the TOPCLASS criteria for isolated anal CD at induction. Conclusion In this cohort of patients with anoperineal fistulas and no evidence of luminal CD, anti-TNF treatment resulted in clinical remission in a quarter of patients within one year. Over a median follow-up of two years, one-sixth of patient were diagnosed with luminal CD. Reference: 1. Hanna LN, Munster LJ, Joshi S, Wendelien van der Bilt JD, Buskens CJ, Hart A, et al. Isolated perianal Crohn’s disease: a systematic review and expert consensus proposing novel diagnostic criteria and management advice. Lancet Gastroenterol Hepatol. 2025;10 (8): 75768. Conflict of interest: Idrissi, Abla: No conflict of interest Fathallah, Nadia: Grant: A. Legrand AbbVie Amgen Biolitec Brothier FCare Systems Janssen Sandoz Takeda THD Lab Tillotts Pharma Altwegg, Romain: Advisory boards from Abbvie, Takeda, Johnson and Johnson, Lilly, Alphasigma, Celltrion, Pfizer, Amgen, Biogen, Sandoz, Ferring Savoye, Guillaume: No conflict of interest De Parades, Vincent: - Clinical research: Brothier, Sandoz, Takeda - Advisory boards: Abbvie - Courses, training, conferences: Abbvie, Amgen, Biolitec, FCare Systems, Janssen, Takeda, THD lab, Tillots Nachury, Maria: Abbvie, Alfa Sigma, Biosynex, Celltrion, Galapagos, Janssen, Lilly, MSD, Pfizer, Takeda Amiot, Aurelien: Personal Fees: Abbvie, Fresenius-Kabi, Adacyte, Tillotts pharma, Janssen, Pfizer, Biogen, AMgen, Sandoz, Takeda, Galapagos, Eli Lilly Abramowitz, Laurent: No conflict of interest Caillo, Ludovic: Abbvie, Amgen, Celltrion, Ferring, Fresenius, Lilly, Jonhson&Jonhson, MSD, Pfizer, Takeda, Sandoz Rouillon, Clea: Abbvie Laharie, David: Personal Fees: Board, consulting and lecture fees from Abbvie, Alfasigma, Amgen, Biocon, Celltrion, Ferring, Fresenius-Kabi, Johnson & Johnson, Lilly, MSD, Pfizer, Sandoz and Takeda Fumery, Mathurin: Grant: Pfizer Personal Fees: Abbvie, Janssen, Takeda, MSD, Biogen, Amgen, Sandoz, Fresenius, Gilead, Celgene, Galapagos, Mylan, Tillots, Ferring, Pfizer, Hospira, CTMA, Boehringer, Lilly, Arena Non-financial Support: Abbvie, Janssen, Takeda, MSD, Galapagos, Ferring, Pfizer Dr. Richard, Nicolas: Lecture/consultant fees from AbbVie, Amgen, Celltrion, Ferring, Janssen, Lilly, Sandoz and Takeda.

Mark Helpful

Bookmark

Relay