The efficacy of ustekinumab in the management of perianal fistulizing Crohn’s disease

1 and certolizumab pegol) are approved, IFX is the only advanced therapy with a dedicated randomized controlled trial to show efficacy for the treatment of perianal disease. 2,3It is recommended in the European Crohn' s and Colitis Organisation guidelines as a first-line medical therapy following adequate drainage of complex perianal fistulas. 4Ustekinumab (UST; an anti-IL-12/23 p40 monoclonal antibody) is a therapy that targets alternative pathways to anti-TNF agents in the CD treatment.This drug appears to have fewer serious side effects and lower immunogenicity without the need for combination therapy with an immunomodulator.Induction (UNITI-1 and UNITI-2) and maintenance trials have suggested that UST was effective for treating moderate to severe CD. [5][6][7] However, the role of UST in treating perianal CD remains limited.Recently, data from subgroup analyses from induction and maintenance trials suggested that UST resulted in some benefit for patients with perianal fistula. 8Until now, there have been few studies on whether UST is useful in Asian patients with perianal CD.In this issue of Intestinal Research, Chen et al. 9 presented a study comparing UST with IFX to determine whether it is useful in patients with perianal fistulizing CD.Although this study is retrospective in nature and includes a relatively small number of patients, this study demonstrates the effectiveness of UST in treating perianal fistula of CD patients naive to biological agents in a real-world setting, particularly in Asian patients with perianal CD.A key finding of this study is the comparison of the efficacy of UST and IFX as the first-line