Evidence map›Paper›PMID 40098436›Full record

Observational studyAlimentary pharmacology & therapeutics2025

The Impact of Setons on Perianal Fistula Outcomes in Patients With Crohn's Disease Treated With Anti-TNF Therapy: A Multicentre Study.

Jeffrey McCurdy, Javeria Munir, Simon Parlow, Gagan Sambhi, Jacqueline Reid, Russell Yanofsky, Talal Alenezi, Joseph Meserve, Kuan-Hung Yeh, Brenda Becker and 12 more

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Alimentary pharmacology & therapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Jeffrey McCurdyDepartment of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Javeria MunirDivision of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.
Simon ParlowDepartment of Medicine, University of Ottawa, Ottawa, Ontario, Canada.ORCID https://orcid.org/0000-0001-9294-4268
Gagan SambhiDepartment of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Jacqueline ReidDepartment of Medicine, UBC, Vancouver, British Columbia, Canada.
Russell YanofskyDivision of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Talal AleneziDivision of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Joseph MeserveDivision of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, USA.
Kuan-Hung YehDivision of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, USA.
Brenda BeckerDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Zubin LahijanianDivision of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada.
Anas Hussam EddinDepartment of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada.
Ranjeeta MallickOttawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Tim RamsayOttawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Greg RosenfeldDepartment of Medicine, UBC, Vancouver, British Columbia, Canada.
Ali BessissowDivision of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada.
Talat BessissowDivision of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Vipul JairathDepartment of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada.ORCID https://orcid.org/0000-0002-1092-0033
David H BruiningDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Blair MacdonaldOttawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Siddharth SinghDivision of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, USA.
Canadian IBD Research Consortium (CIRC)

Funding

Comparative effectiveness research in Hispanic patients with inflammatory bowel diseasesR01DK135937 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Siddharth Singh · 2024 to 2026
$1.9M
Canadian IBD Research ConsortiumNIDDK NIH HHS R01 DK135937
6 · The paper itself

Abstract

BACKGROUND AND

aimsWe aimed to assess the impact of setons on perianal fistula outcomes in patients with perianal fistulising Crohn's disease (PFCD) treated with anti-TNF therapy.

methodsWe included patients treated with their first anti-TNF 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-TNF 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.

resultsOur analysis included 221 patients: 81 with setons and 140 without setons. After cardinality matching, our cohorts were balanced (standardised difference < 0.1 for all covariates). Patients with setons had similar rates of MAFO (HR 1.23; 95% CI, 0.68-2.21) and fistula remission at 6 months (OR, 0.81; 95% CI, 0.41-1.59) and 12 months (OR, 0.63; 95% CI, 0.31-1.27) 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, 0.19-1.25) but not statistically significant in patients with setons.

conclusionsIn this multicentre, setons were not associated with improved fistula outcomes. Future prospective controlled studies are warranted.

Indexed as

Crohn DiseaseRectal FistulaTumor Necrosis Factor-alphaAdultFemaleHumansInfliximabMagnetic Resonance ImagingMaleMiddle AgedTreatment OutcomeYoung AdultInfliximabTumor Necrosis Factor-alphacomparative effectivenessmultidisciplinary careperianal fistulasetons

Identifiers

PMID40098436
PMCPMC12239943

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.