Intest Res.  2022 Apr;20(2):240-250. 10.5217/ir.2021.00091.

Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis

• Ayoub F
• Odenwald M
• Micic D
• Dalal SR
• Pekow J
• Cohen RD
• Rubin DT
• Sakuraba A

• KMID: 2529570
• DOI: http://doi.org/10.5217/ir.2021.00091

Abstract

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.

Keyword

Vedolizumab; Perianal fistula; Perianal disease; Crohn disease; Meta-analysis

Figure

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  Fig. 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram depicting the selection process of studies used in the analysis.

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  Fig. 2. Forrest plot demonstrating pooled rate and 95% confidence interval (CI) of complete healing of perianal fistulizing disease. ES, effect size; DL, DerSimonian-Laird method.

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  Fig. 3. Forrest plot demonstrating pooled rate and 95% confidence interval (CI) of partial healing of perianal fistulizing disease. ES, effect size; DL, DerSimonian-Laird method.

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