Cx601 (darvadstrocel) for the treatment of perianal fistulizing Crohn’s disease

ABSTRACT

Introduction: Given the well-documented difficulty to treat perianal fistulizing Crohn’s disease (pCD), with 40% of patients experiencing recurrence even after reiterative surgery and advanced medical therapy, research in this field has focused on the role of mesenchymal stem cells (MSC).

Areas covered: The aim of this article is to furnish an overview of the pathogenetic mechanisms, clinical applications and evidences for the use of MSC for pCD with particular focus on adipose-derived allogenic MSC including darvadstrocel.

Expert Opinion: The effect of MSC on fistula healing is probably mediated by their anti-inflammatory properties more than by their ability to engraft and trans-differentiate in the healthy tissue. A holistic treatment of pCD, addressing different pathophysiological factors, may represent the key for an improvement in the healing rate. In this setting, MSC might play a role as ‘augmentation’ therapy in combination with more conventional treatments. Whether MSC have benefit in non-complex fistula in biological naïve patients, in complex fistula with many tracts and/or in rectovaginal fistulas, are unexplored fields that need further investigation. A central registry of pCD patients undergoing treatment with MSC should be created in order to elucidate the efficacy, safety and costs of stem cells treatment on long term follow up.

KEYWORDS:

• Crohn’s disease
• perianal fistula
• mesenchymal stem cells

Article highlights

• Perianal fistulizing Crohn’s disease (pCD) tipically follows a relapsing and remitting course. Forty percent of the patients experience recurrence even after reiterative surgery and advanced medical therapy.

• Uncontrolled inflammatory response has probably a major role in determining fistula perpetuation in Crohn’s disease (CD).

• Mesenchymal stem cells (MSC) have emerged as a promising alternative to conventional medical and surgical treatment for tissue regeneration and repair due to their anti-inflammatory properties.

• Based on the results from a large phase III study (ADMIRE-CD), the administration of Cx601-darvadstrocel produces a gain of 15% in the remission rate in the context of a difficult to treat pCD population with refractory and complex perianal fistulas. Long-term efficacy has been confirmed.

• Whether MSC have benefit in non-complex fistula in biological naïve patients, in complex fistula with many tracts and/or in rectovaginal fistulas, are unexplored fields that need further investigation.

Declaration of interest

M Ferrante received financial support for research from Pfizer, Takeda, and Janssen; lecture fees from Ferring, Boehringer-Ingelheim, Chiesi, Merck Sharpe & Dohme, Tillotts, Janssen Biologics, Abbvie, Takeda, Mitsubishi Tanabe, Zeria; consultancy fees from Abbvie, Boehringer-Ingelheim, Ferring, Merck Sharpe & Dohme, and Janssen Biologics. S Vermeire has received grant support from AbbVie, MSD, Pfizer, J&J, and Takeda; received speaker fees from AbbVie, MSD, Takeda, Ferring, Dr. Falk Pharma, Hospira, Pfizer Inc and Tillots; and served as a consultant for AbbVie, MSD, Takeda, Ferring, Genentech/Roche, Robarts clinical trials, Gilead, Celgene, Prometheus, Avaxia, Prodigest, Shire, Pfizer Inc, Galapagos, Mundipharma, Hospira, Celgene, Second Genome, and Janssen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

One of the peer reviewers has served on an Advisory Board for Takeda Italy for Darvadstrocel. Three additional peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.