Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas

Abstract

Crohn’s disease (CD) is an inflammatory bowel disease with increasing incidence and prevalence worldwide. Perianal fistulas are seen in up to 26% of CD patients and are often refractory to medical therapy. Current treatments for CD perianal fistulas (pCD) include antibiotics, biologics, and for refractory cases, fecal diversion (FD) with ileostomy or colostomy. Mesenchymal stem/stromal cell therapy (MSCs) is a new modality that have shown efficacy in treating pCD. MSCs locally injected into pCD can lead to healing, and a phase III clinical trial (ADMIRE-CD) showed 66% clinical response, leading to approval of MSCs (Alofisel, Takeda) in the European Union. It is unclear if MSCs would be more cost-effective than the current standard of FD. We therefore developed a decision tree model to determine the cost-effectiveness of MSCs compared to FD for pCD. Our study showed that both autologous and allogeneic MSCs are more cost-effective than FD in an academic medical center and even in a worst-case scenario with 100% chance of all complications for MSCs treatment and 0% chance of complications for FD, both allogeneic and autologous MSCs are still cost saving compared to FD.

Senescence induces fundamental changes in the secretome of mesenchymal stromal cells (MSCs): implications for the therapeutic use of MSCs and their derivates

“…The self-renewal, in vitro expandability, multipotent differentiation capacity, being less prone to senescence, and non-immunogenic but still immunomodulatory properties of MSCs from various tissue sources have attracted researchers for their clinical applications in the field of regenerative diseases ( Zhang et al, 2015 ; Alessio et al, 2018 ; Alessio et al, 2019b ). MSCs are candidates for cell-based therapeutic strategies for various disease conditions including neurodegenerative disorders, where clinical stabilization of non-option Parkinsonism was observed for at least 6 months, improvements observed in cardiovascular diseases, perianal fistulas associated with Crohn’s disease, COVID-19, bone disorders, and cancers ( Giordano et al, 2014 ; Canesi et al, 2016 ; Kastrup et al, 2017 ; Liu S. et al, 2020 ; Cheng et al, 2020 ; Hmadcha et al, 2020 ; Wang et al, 2021 ; Johnson et al, 2022 ; Shi et al, 2022 ; Sohrabi et al, 2022 ). A clinical trial on the safety and feasibility of adipose-derived stromal cells also demonstrated a safe and feasible treatment of ischemic heart diseases and heart failure ( Kastrup et al, 2017 ).…”