Efficacy and safety of perianal surgery plus anti-TNF-alpha monoclonal antibody sequential treatment in adult patients with perianal fistula of Crohn′s disease: a meta-analysis

Objective To compare the efficacy and safety of perianal surgery plus anti-TNF-alpha monoclonal antibody sequential treatment with single perianal surgery and anti-TNF-alpha administration in adult patients with perianal fistula of Crohn′s disease (CD) . Methods PubMed, EMBASE and Cochrane database were searched to find relevant clinical studies (experimental and observational studies) . The primary outcome of the study was the response rate of perianal fistula, and the secondary target was the recurrence rate of perianal fistula. Results Eight control studies were enrolled, including three prospective studies and five retrospective studies with a total of 688 subjects. Meta-analysis showed that the sequential treatment group did not significantly improve the perianal fistula healing rate compared with the perianal surgery group (78.5% vs. 65.2%, OR= 2.21, 95% CI: 0.83~ 5.90, P= 0.11) . There was no significant difference between two groups in the complete healing rate and partial healing rate of perianal fistula, but the recurrence rate of perianal fistula in sequential treatment group was lower than that in perianal surgery group (20.8% vs. 76.1%, OR= 0.10, 95% CI: 0.03~ 0.37, P= 0.0006) . There was no significant difference in perianal fistula healing rate and the incidence of adverse reactions between sequential treatment group and anti-TNF-α monoclonal antibody group, but the former had a lower risk of preventing fistula recurrence (30.0% vs. 69.2%, OR= 0.24, 95% CI: 0.06~ 0.93, P= 0.04, n= 57) . Common adverse reactions in sequential treatment group included headache, mild chest pain, mild infusion reaction, allergic reaction, muscle weakness, abdominal pain and sepsis, which were main anti-TNF-α monoclonal antibody-related adverse reactions. Conclusion Sequential treatment does not significantly improve the perianal fistula healing rate, but reduces the recurrence rate of perianal fistula compared to single treatments, while not increasing the incidence of adverse reactions. Key words: Anti-TNF-alpha monoclonal antibody; Perianal surgery; Sequential treatment; Crohn′s disease; Perianal fistula; Meta-analysis