Introduction: Crohn’s perianal fistulas (CPFs) are a common complication of Crohn’s disease, and patients with CPF have a high treatment burden that can negatively affect their quality of life (QoL). This study aimed to assess patient satisfaction with current CPF treatments and preferences for future CPF treatment attributes.
Methods: A US observational study was conducted among patients aged ≥21 and ≤89 years with self-reported physician-diagnosed CPF (±CPF-related surgery). Using a web-enabled questionnaire, patient satisfaction with CPF treatments and treatment attribute importance over the past 12 months were rated using a 1–9 scale (1=not at all satisfied, 9=extremely satisfied). A discrete choice experiment (DCE) evaluated patient preferences for future CPF treatment attributes. Data were analyzed using descriptive statistics and hierarchical Bayesian modeling for DCE.
Results: In total, 100 patients were recruited, with a mean (standard deviation [SD]) age of 40.0 [12.2] years. Mean number of unique CPFs was 2.7 [2.4], mean disease duration since diagnosis was 9.1 [9.9] years and 53% reported having complex fistula.
For those who had CPF-related surgery and/or seton placement, treatment satisfaction was highest for fistulectomy/fistulotomy and ligation of the intersphincteric fistula tract and lowest for fibrin glue, short- and long-term setons (Table). Biologics were used by 90% of patients, infliximab having the highest overall satisfaction (6.6 [2.5]). Patient attitudes toward current CPF treatments identified a need for new treatment options (7.1 [1.8]).
For all patients, improvement in QoL (60%) and avoidance of future surgery (50%) were the most important treatment goals. A lower risk of symptom recurrence (8.2 [1.1]), quick improvement in QoL (8.1 [1.1]), reduction in fistula/no large abscess (8.0 [1.4]) and better symptom control (8.0 [1.3]) were the most important current treatment attributes.
The DCE identified symptom control/fistula closure, then post-operative discomfort as the most important attributes for therapies (Figure). Patients considered low fecal incontinence important and preferred procedures with minimal cutting/puncturing and those where treatments were injected into the anal area.
Discussion: Improvements in patient CPF treatment satisfaction and new treatments are required. Clinical development of CPF treatments should consider patient-centric attributes for clinical trial endpoints and when assessing treatment effectiveness.
