Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

JAMA Network Open
Jeremy AdlerKevin J Dombkowski

Abstract

Perianal fistulizing complications (PFCs) develop in 15% to 30% of patients with Crohn disease (CD), are difficult to treat, worsen quality of life, increase cost of care, and commonly recur. Evidence-based strategies to prevent PFCs are lacking. To investigate the effectiveness of medical therapy for reducing risk of PFCs among young people with CD and to test the hypothesis that steroid-sparing therapy (SST) use would be associated with reduced risk of PFC development. In this comparative effectiveness analysis of commercial administrative claims from January 1, 2001, through June 30, 2016, patients who did or did not initiate SST were matched via propensity score to adjust for all available confounders. Using Optum's Clinformatics Data Mart, a deidentified database of US commercial administrative claims, all patients aged 5 to 24 years with CD (January 1, 2001, through June 30, 2016) were identified. The index date was the CD diagnosis date. Patients with PFCs or SST use at or before CD diagnosis were excluded. The dates of analysis were October 2017 to February 2020. The primary exposure of interest was SST initiation, including immunomodulators and/or anti-tumor necrosis factor α (anti-TNFα) medications, initiated before e...Continue Reading

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Citations

Jun 10, 2020·JAMA Network Open·Sunanda V Kane
Apr 10, 2021·Inflammatory Bowel Diseases·Jeremy AdlerAndrew A M Singer
Apr 27, 2021·Current Opinion in Gastroenterology·Suha AbushammaParakkal Deepak
Jul 11, 2021·Advances in Pediatrics·Nathan S Rubalcava, Samir K Gadepalli
Jul 22, 2021·International Journal of General Medicine·Feihong DengXuehong Wang
Aug 21, 2021·Journal of Pediatric Gastroenterology and Nutrition·Prashanthi KandavelUNKNOWN ImproveCareNow Network Pediatric IBD Learning Health System

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