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* = Presenting author

P278. MRI guided biologic therapy for Crohn's perianal fistulae: 3 year follow up data

P. Tozer1,2, S. Ng1, S. Plamondon1, A. Gupta1, A. Swatton1, S. Tripoli1, N. Arebi1, C.J. Vaizey1, M.A. Kamm3, R.K.S. Phillips1,2, D. Burling1,2, A.L. Hart1,2

1St Mark's Hospital, London, United Kingdom; 2Imperial College, London, United Kingdom; 3St Vincent's Hospital and University of Melbourne, Melbourne, Australia

Background: Biologic drugs improve many Crohn's anal fistulae clinically but the rate, extent and durability of deep tissue healing, and factors influencing long term outcome are unknown.

Methods: Consecutive patients with Crohn's-related perianal (anal, rectovaginal, ano-labial) fistulae treated with infliximab or adalimumab were monitored clinically and radiologically using MRI.

Results: Forty-one consecutive patients were treated with infliximab (32) or adalimumab (16; following infliximab failure) for Crohn's-related perianal fistulae. Thirty-three percent of infliximab treated patients were in clinical remission at 3 years. Radiological healing lagged behind clinical remission by 13 months (SD = 28 months). The number of fistulae and the presence of a stoma at baseline influenced clinical remission. Patients who achieved early clinical response at 6 weeks were 5 times more likely to ultimately undergo clinical remission than those who did not (P = 0.004). Radiologically healed fistula tracts were at risk of recrudescence after cessation of therapy.

Conclusions: There is a durable response to biologic treatment of Crohn's perianal fistulae. Radiological healing lags behind clinical healing by over a year implying that long periods of therapy may be necessary.