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INTRODUCTION Crohn’s perianal fistulas (CPFs) are a common complication of Crohn’s disease and treated with both medical and surgical interventions. This study aimed to characterize the experience and satisfaction of healthcare professionals (HCPs) with current CPF treatments and assess HCP preferences for future CPF treatment attributes. METHODS A US observational study recruited gastroenterologists (GEs) and surgeons who managed at least three patients with CPF in the past 12 months and spent ≥ 70% of their professional time treating patients. Using a web-enabled questionnaire, HCP satisfaction with CPF treatments and attitudes towards CPF care were rated using a 1–9 scale (1 = not at all satisfied/strongly disagree, 9 = extremely satisfied/strongly agree). A discrete choice experiment (DCE) evaluated HCP preferences for future treatment attributes. Data were analyzed using descriptive statistics and hierarchical Bayesian modeling for DCE. RESULTS In total, 137 HCPs were recruited (GEs, n = 77; surgeons, n = 60) with a mean (standard deviation [SD]) of 15.6 (7.8) years in active clinical practice. The mean (SD) number of patients with CPF per HCP was 29.4 (16.7), and 41% of patients had moderate disease severity. Overall, HCPs reported moderate satisfaction with current CPF treatment (medication or surgical) attributes (Table). HCP satisfaction scores for each CPF medication and surgical procedure were low to moderate (mean range [SD]: 3.4 [2.1]–6.7 [1.5]; 4.2 [2.2]–5.7 [1.6], respectively) with biologics rated highest for medications (4.7 [2.2]–6.7 [1.5]), and short- or long-term seton placement highest for surgical procedures (mean [SD]: 5.7 [1.6] and 5.5 [1.7], respectively). HCP attitudes towards current CPF interventions (mean score [SD]) revealed a need for better treatments (7.4 [1.5]), a concern for CPF recurrence despite treatment (7.2 [1.4]), that current treatments may not reduce risk of fecal incontinence (FI) (6.8 [1.4]), and that setons are a good short- but not long-term solution for CPF (6.5 [1.8]). Achieving fistula closure was the most important treatment goal for HCPs (57%), with improvement in quality of life (mean score [SD]: 7.7 [1.3]), low chance of symptom recurrence (7.5 [1.4]), minimal risk of FI (7.5 [1.4]) and sustained efficacy post treatment (7.5 [1.5]) the main attributes influencing treatment decisions. The DCE identified symptom control and/or fistula closure and low FI rates as the most important future CPF treatment attributes (Figure). CONCLUSIONS HCPs were unsatisfied with current CPF treatments, highlighting a need for better treatments. From an HCP’s perspective, future CPF therapies should control symptoms, promote fistula closure, and low rates of FI.

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Background Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that can lead to complications such as perianal fistulas (PAFs). This study compared disease burden, experiences and health-related quality of life between patients who have CD with PAFs (CPF) and those who have CD without PAFs (non-PAF CD). Methods This cross-sectional, observational study was conducted in three cohorts of US patients aged 18–89 years with self-reported physician-diagnosed CD: (1) non-PAF CD; (2) CPF without PAF-related surgery; and (3) CPF with PAF-related surgery. Data on medical and surgical interventions, CD-specific symptoms and Fecal Incontinence Quality of Life (FIQL) were collected via a web-enabled questionnaire. Statistical comparisons were assessed at the 0.05 level. Results The mean (standard deviation) age of patients in cohorts 1 (n = 300), 2 (n = 51) and 3 (n = 52) was 47 (16.4), 40 (12.2) and 39 (13.1) years, respectively. In patients with CPF (cohort 2 + 3), 59 (57%) reported multiple fistulas and 48 (47%) reported fistula recurrence/persistence. Compared with cohort 1 (non-PAF CD), more patients with CPF reported currently receiving biologic treatment or immunomodulators for CD (58% vs 43% and 23% vs 15%, respectively; both p = 0.01). More patients with CPF also reported undergoing ≥ 1 CD-related surgery and experiencing ≥ 1 failures of CD-related surgery (79% and 20%, respectively) versus cohort 1 (53% and 9%, respectively; both p < 0.001). In cohort 3, 63% of patients had ≥ 3 PAF-related surgeries, and in those receiving seton placement (n = 37), 8% reported placement failure. Post-surgical/seton placement complications were common; the most frequently reported were worsening of pain and swelling around the anus (33%) and fever/infection (29%). CD-specific symptom frequency and severity results indicated a high symptom burden across cohorts; fatigue was reported with the highest frequency and severity. Faecal incontinence (FI) and leakage-related symptoms affected greater proportions of patients in cohorts 2 and 3, often with greater severity and frequency, compared with cohort 1 (Fig.1). Across all cohorts, 58% of patients (cohort 1/2/3, n = 158/35/40) reported experiencing FI and completed the FIQL questionnaire: cohorts 2 and 3 reported lower (worse) FIQL scores across domains than cohort 1 (Fig.2). Conclusion The burden of illness in patients with CPF is substantial, with medical and surgical intervention rates, and symptom severity and frequency greater than for those with non-PAF CD. Higher disease burden, including FI, was noted in patients with CPF compared with the non-PAF CD cohort. An unmet need remains for improved management and outcomes of CPF. Sponsor: Takeda Pharmaceuticals USA, Inc.