{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T09:35:36Z","timestamp":1782207336602,"version":"3.54.5"},"reference-count":37,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>We aimed to assess the impact of setons on perianal fistula outcomes in patients with perianal fistulising Crohn's disease (PFCD) treated with anti\u2010TNF therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included patients treated with their first anti\u2010TNF therapy for PFCD after undergoing a pelvic MRI between 2005 and 2022 from 6 North American centres. Our exposure was one or more setons at the time of anti\u2010TNF therapy. Our primary outcome was major adverse fistula outcome (MAFO), a composite of repeat local surgical intervention, hospitalisation, or faecal diversion for PFCD, and our secondary outcome was fistula remission defined clinically. We used 1:1 cardinality matching and propensity score weighting to control for fistula severity based on centrally read MRIs, luminal characteristics, and concomitant therapies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our analysis included 221 patients: 81 with setons and 140 without setons. After cardinality matching, our cohorts were balanced (standardised difference &lt;\u20090.1 for all covariates). Patients with setons had similar rates of MAFO (HR 1.23; 95% CI, 0.68\u20132.21) and fistula remission at 6\u2009months (OR, 0.81; 95% CI, 0.41\u20131.59) and 12\u2009months (OR, 0.63; 95% CI, 0.31\u20131.27) compared to patients without setons. Our results remained stable when analysed by propensity score weighting and in a sensitivity analysis of patients who underwent an exam under anaesthesia. In patients with abscesses, there were lower rates of MAFO (HR, 0.49; 95% CI, 0.19\u20131.25) but not statistically significant in patients with setons.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this multicentre, setons were not associated with improved fistula outcomes. Future prospective controlled studies are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.70081","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T07:14:31Z","timestamp":1742282071000},"page":"1671-1679","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The Impact of Setons on Perianal Fistula Outcomes in Patients With Crohn's Disease Treated With Anti\u2010<scp>TNF<\/scp> Therapy: A Multicentre Study"],"prefix":"10.1111","volume":"61","author":[{"given":"Jeffrey","family":"McCurdy","sequence":"first","affiliation":[{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"},{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javeria","family":"Munir","sequence":"additional","affiliation":[{"name":"Division of Diagnostic Imaging The Ottawa Hospital  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9294-4268","authenticated-orcid":false,"given":"Simon","family":"Parlow","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gagan","family":"Sambhi","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Medicine UBC  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Yanofsky","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine McGill University Health Center  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talal","family":"Alenezi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine McGill University Health Center  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Meserve","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan\u2010Hung","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Becker","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zubin","family":"Lahijanian","sequence":"additional","affiliation":[{"name":"Division of Diagnostic Imaging McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas Hussam","family":"Eddin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjeeta","family":"Mallick","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Ramsay","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"Department of Medicine UBC  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bessissow","sequence":"additional","affiliation":[{"name":"Division of Diagnostic Imaging McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talat","family":"Bessissow","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine McGill University Health Center  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1092-0033","authenticated-orcid":false,"given":"Vipul","family":"Jairath","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Bruining","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blair","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"},{"name":"Division of Diagnostic Imaging The Ottawa Hospital  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddharth","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Canadian IBD Research Consortium (CIRC)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"issue":"4","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/ecco-jcc\/jjad185","article-title":"Pharmacological Therapies for the Management of Fistulising Crohn's Disease: A Systematic Review and Meta\u2010Analysis","volume":"18","author":"Vuyyuru S. K.","year":"2023","journal-title":"Journal of Crohn's & Colitis"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.12295"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izab287"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-020-01622-7"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3182099d9e"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-320553"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v24.i42.4821"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izy247"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-306709"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjw169"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00054725-200303000-00003"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800820112"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000002369"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-021-04987-2"},{"issue":"5","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/ibd\/izac143","article-title":"Examination Under Anesthesia May Not be Universally Required Prior to Anti\u2010TNF Therapy in Perianal Crohn's Disease: A Comparative Cohort Study","volume":"29","author":"Chan M.","year":"2022","journal-title":"Inflammatory Bowel Diseases"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco\u2010jcc\/jjae035"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199905063401804"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gastro.2003.08.025"},{"issue":"5","key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/j.cgh.2023.12.006","article-title":"Development of an MRI\u2010Based Prediction Model for Anti\u2010TNF Treatment Failure in Perianal Crohn's Disease: A Multicenter Study","volume":"22","author":"McCurdy J.","year":"2023","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.20555"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.07.027"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.2003.07241.x"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3356"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjaa004"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.14969"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-007-9077-3"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(22)00007-3"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(22)00088-7"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-019-05635-1"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.07.053"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13970"},{"issue":"6","key":"e_1_2_11_33_1","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1093\/ecco-jcc\/jjad214","article-title":"Scoring Indices for Perianal Fistulizing Crohn's Disease: A Systematic Review","volume":"18","author":"Vuyyuru S. K.","year":"2023","journal-title":"Journal of Crohn's & Colitis"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco\u2010jcc\/jjab168"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.509"},{"key":"e_1_2_11_36_1","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1007\/s00330-024-11029-3","article-title":"External Validation of the MAGNIFI\u2010CD Index in Patients With Complex Perianal Fistulising Crohn's Disease","volume":"35","author":"Beek K. J.","year":"2025","journal-title":"European Radiology"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.18466"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31203-X"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70081","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T15:47:22Z","timestamp":1745336842000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.70081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":37,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1111\/apt.70081"],"URL":"https:\/\/doi.org\/10.1111\/apt.70081","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,18]]},"assertion":[{"value":"2025-01-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}