{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:10:19Z","timestamp":1791483019760,"version":"4.3.4"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fistulas are a debilitating complication of Crohn\u2019s disease [CD]. We conducted a systematic review to assess the efficacy of medical therapies for fistulizing CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MEDLINE, Embase, and CENTRAL were searched on May 26, 2022, for randomized controlled trials [RCTs] of pharmacological therapy in adults with fistulizing CD. The primary outcome was induction and maintenance of fistula response. Pooled risk ratios [RRs] and 95% confidence intervals [CIs] were calculated. GRADE was used to assess the certainty of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-eight RCTs were included. Nineteen trials [50%] exclusively involved perianal fistula. The remaining studies included some participants with non-perianal fistula. Pooled RRs for anti-tumour necrosis factor [TNF] agents were not statistically significant for induction [RR 1.36, 95% CI 0.97\u20131.91] or maintenance of fistula response [RR 1.48, 95% CI 0.97\u20132.27]. However, in a sensitivity analysis of studies with fistula response as the primary outcome, anti-TNFs were superior to placebo for induction [RR 1.94, 95% CI 1.10\u20133.41] and maintenance [RR 1.88, 95% CI 1.23\u20132.88] of fistula response. Oral small molecules [RR 2.56, 95% CI 1.18\u20135.53] and mesenchymal stem cell [MSC] therapy [RR 1.26, 95% CI 1.01\u20131.57] were effective for induction of fistula response. Ustekinumab was associated with maintenance of fistula response [RR 1.80, 95% CI 1.04\u20133.11]. Vedolizumab was not superior to placebo. The certainty of evidence ranged from very low to moderate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Very low- to moderate-certainty evidence suggests that anti-TNF therapy, oral small molecules, ustekinumab, and MSCs are effective for perianal fistulizing CD. Dedicated fistula studies evaluating biologics and small molecules are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjad185","type":"journal-article","created":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T01:24:37Z","timestamp":1698801877000},"page":"589-603","source":"Crossref","is-referenced-by-count":40,"title":["Pharmacological Therapies for the Management of Fistulizing Crohn\u2019s Disease: A Systematic Review and Meta-Analysis"],"prefix":"10.1093","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8281-3237","authenticated-orcid":false,"given":"Sudheer K","family":"Vuyyuru","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Schulich School of Medicine, Western University , London, ON , Canada"},{"name":"Alimentiv Inc , London, ON , 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