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P269. Effectiveness of the available therapeutic options in the treatment of perianal fistulas in patients with Crohn's disease (CD)

M. Chaparro1, P. Burgueño1, I. Vera2, F. Bermejo3, I. Martín-Jiménez4, C. Yela5, P. López6, M. Martín7, C. Taxonera8, B. Botella9, R. Pajares10, A. Ponferrada11, M. Calvo2, A. Algaba3, L. Pérez4, B. Casis5, J. Maté1, J.P. Gisbert1

1Hospital de la Princesa, Madrid, Spain; 2Hospital Puerta de Hierro, Madrid, Spain; 3Hospital de Fuenlabrada, Madrid, Spain; 4Hospital Gregorio Marañón, Madrid, Spain; 5Hospital Doce de Octubre, Madrid, Spain; 6Hospital de Alcorcón, Madrid, Spain; 7Hospital de la Paz, Madrid, Spain; 8Hospital Clinico San Carlos, Madrid, Spain; 9Hospital Infanta Cristina, Madrid, Spain; 10Hospital Infanta Sofía, Madrid, Spain; 11Hospital Infanta Leonor, Madrid, Spain

Objective: Estimate the effectiveness of the different options for the treatment of perianal fistulas in CD patients.

Methods: A retrospective study of CD patients with perianal complications was conducted in 11 hospitals in Madrid. Data was collected on the demographic characteristics, type of fistula, treatments and the outcome thereof. Response was evaluated according to the Fistula Drainage Assesment Index.

Results: 296 CD patients with perianal fistula were included. The mean age was 41 years and 55% were male. 87% of the patients had complex perianal fistula and 13% had simple perianal fistula. 64% of the patients had received antibiotics, 74% immunosuppressants, 56% anti-TNF and 70% had undergone surgical intervention. The most commonly administered antibiotic was metronidazol (54%), the median treatment duration was 1.7 months and the median dose was 1,500 mg/day. 33% of patients had a complete response (60% simple vs. 31% complex). The most commonly administered immunosuppressants were thioprines (89%). The median treatment duration was 12 months. The median dose of azathioprine was 160 mg/day and of mercaptopurine was 100 mg/day. 32% of patients had complete response (58% simple vs. 29% complex). Infliximab was the anti-TNF drug administered in 74% of cases, and adalimumab in 26%. The median treatment duration was 9 months. 50% of patients had complete response (67% simple vs. 49% complex). The most common surgical intervention was fistulotomy (29%), followed by placement of setons (26%) and abscess drainage (24%). 48% of patients had complete response (85% simple vs. 45% complex). Recurrence of fistulas treated with antibiotics was observed in 65% of the cases (46% simple vs. 66% complex), in 45% of the cases with immunosuppressants (30% simple vs. 47% complex), in 43% of the cases with anti-TNF drugs (25% simple vs. 44% complex) and in 52% of the cases treated with surgical intervention (25% simple vs. 54% complex). Antibiotic treatment was discontinued in 5% of patients due to adverse events, immunosuppressants in 18% and anti-TNF therapy in 14% of the cases.

Conclusions: Response to the available options for the treatment of perianal fistulas in CD patients is low. There is a high percentage of fistula recurrence in patients who had initial response to the treatment. A significant proportion of patients have to discontinue the treatment due to adverse events. Therefore the effectiveness of the treatments available for perianal fistulas in patients with CD is very limited.