Gregory D. Salinas, PhD1, Emily D. Belcher, BS1, Susan E. Cazzetta, PharmD2, Pradeep P. Nazarey, MD3, Sylvie Stacy, MD, MPH1 1CE Outcomes, LLC, Birmingham, AL; 2Takeda, Lexington, MA; 3Takeda-USBU, Lexington, MA
Introduction: Crohn’s-related perianal fistulas (CPF) contribute to lowered quality of life for patients with Crohn’s disease (CD). This study aimed to identify practice patterns and knowledge gaps in CPF management.
Methods: To understand perspectives of gastroenterologists (GIs) and GI nurse practitioners/physician assistants (NP/PAs) managing patients with CPF, a case-based survey was developed related to management of initial presentation and CPF recurrence. Surveys were distributed online to GIs/NPs/PAs with CPF experience (at least 1 CPF patient per month) in Sep/Oct 2020.
Results: Surveys were collected from 127 gastroenterologists and 63 GI NP/PA; 24% of GIs and 35% of GI NPs/PAs were from academic settings. There was little agreement in CPF classification/scoring tools, with many GI NP/PAs (39%) and GIs (44%) choosing no classification system, and ways to distinguish simple versus complex CPF was inconsistent.
Most participants agreed that controlling CD activity was very important, and most recommended an anti-TNF as initial pharmacotherapy. Thereafter, there was no agreement on next steps including medication adjustments, how long to leave a seton in place or when to refer to surgery.
GIs and NP/PAs differed on whether fistula healing or improved quality of life was the most important long-term CPF goal. GIs were likely or very likely to discuss quality of life issues and general information about surgical management options with patients, but fewer discussed medication adverse effects or investigational options. Familiarity of investigational treatments was low, including 86% of HCPs not at all or slightly familiar with stem cell treatments.
Barriers to optimal management of CPF were lack of effective medicines (64%), patient reluctance (49%), delayed referral/diagnosis (43%), and lack of guidelines/treatment algorithms (41%). COVID-19 did not have a major effect on patient management.
Collaboration with colorectal surgeons on management plans occurred with 42% of GIs and 32% of NP/PAs. Barriers to effective multidisciplinary CPF management included logistical difficulty in coordinating care (40%), lack of access to specialists (38%), lack of communication of treatment plans (30%). Patient involvement in management decisions was considered by 47% of GIs and 60% of NPs/PAs.
Discussion: There is no consensus on how to best manage CPF. Education is needed to improve outcomes in CPF treatment.
Gregory Salinas indicated no relevant financial relationships.
Emily Belcher indicated no relevant financial relationships.
Susan Cazzetta: Takeda Pharmaceuticals USA, Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).
Sylvie Stacy indicated no relevant financial relationships.
Gregory D. Salinas, PhD1, Emily D. Belcher, BS1, Susan E. Cazzetta, PharmD2, Pradeep P. Nazarey, MD3, Sylvie Stacy, MD, MPH1. P1602 - Medical Management of Patients With Complex Perianal Fistula: Results of a U.S. National Case-Based Survey to Determine Future Educational Needs, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.