The Outcomes of Biologic Therapies for Fistulizing Crohn's Disease: A Systematic Review

Background: Fistulizing Crohn's Disease (FCD) is a distinct and aggressive subset of Crohn's Disease, contributing to substantial morbidity, hospitalizations, and reduced patient well-being. The intricate interplay of factors influencing FCD outcomes warrants an in-depth exploration to refine patient care and therapeutic strategies. The aim of this paper is to conduct a comprehensive systematic review to critically evaluate the effectiveness, safety, and cost-effectiveness of biologic therapies and other interventions for FCD Methods: In line with the PRISMA Statement 2020 guidelines, we conducted a systematic review. We extensively searched databases including PubMed, Embase, and Cochrane Library, with the last search update on November 5, 2023. Studies evaluating FCD patients were examined, emphasizing the disease's clinical burden and influential parameters. Observational studies that underlined treatments and various FCD management strategies correlating with clinical outcomes were primarily considered for inclusion. Results: Beginning with an initial review of 438 studies, ten met the inclusion criteria and were incorporated into this systematic review. A total of 1122 patients were included. Spanning the years 2014–2022, the incorporated studies delve into diverse FCD treatment modalities. These range from the use of anti-TNF agents, surgical procedures, stem cell therapies, drug amalgamations, to intensifying dosing regimens. The synthesized findings from these studies carve out a progressively evolving treatment milieu for Crohn's disease, emphasizing the indispensability of individualized and empirically supported therapeutic avenues. Conclusion: FCD presents a formidable challenge in the realm of inflammatory bowel diseases, impacting patient outcomes. This review accentuates the pivotal nature of comprehensive care, early intervention, and addressing intricate disease mechanisms. The collated evidence highlights an imperative for innovative care modalities, targeted therapeutic endeavors, and tailored interventions to manage FCD more effectively and improve patient prognosis.