Ustekinumab Shows Promise for Perianal Fistulizing Crohn’s Disease, Review Finds

What To Know

The review highlights mechanistic reasons ustekinumab could work for fistulizing disease and compiles findings from randomized trials, subgroup analyses, and multiple real‑world cohorts that report higher fistula response and remission rates with ustekinumab than with placebo or historical controls.

Some maintenance and longer‑term observational data suggest effects may increase over time. However, most perianal data come from subgroup analyses, retrospective cohorts, and trials not powered for fistula endpoints; the authors call for prospective, fistula‑specific randomized trials.

Reported imaging improvements (MRI) and use of surgical management such as seton placement are common in the datasets reviewed. If you’re considering treatment changes, discuss with your gastroenterologist how the available evidence applies to your specific fistula type, prior biologic exposure, and need for combined medical/surgical care.