P531. Effectiveness of anti-TNF agents in the treatment of entero-urinary fistulas in Crohn's disease
C. Taxonera1, I. Fernández-Blanco2, M. Barreiro-de Acosta3, G. Bastida4, A. López-San Román5, O. Merino6, V. García-Sánchez7, J.P. Gisbert8, I. Marín-Jiménez9, P. López-Serrano10, E. Iglesias7, J. Martínez-González5, M. Chaparro8, C. Saro11, F. Bermejo12, L. Pérez-Carazo9, R. Plaza13, D. Olivares1, J.L. Mendoza1, E. Rey14, 1H Clinico San Carlos, IBD Unit, IdiSSC, Madrid, Spain, 2Hospital Moncloa, Madrid, Spain, 3H Clínico de Santiago, Santiago de Compostela, Spain, 4H La Fe, Valencia, Spain, 5H Ramón y Cajal, Madrid, Spain, 6H Cruces, Barakaldo, Spain, 7H Reina Sofía, Córdoba, Spain, 8H La Princesa, CIBERehd, Madrid, Spain, 9H Gregorio Marañón, Madrid, Spain, 10H Alcorcón, Madrid, Spain, 11H de Cabueñes, Gijón, Spain, 12H Fuenlabrada, Madrid, Spain, 13H Infanta Leonor, Madrid, Spain, 14H Clinico San Carlos, IdiSSC, Madrid, Spain
The success of medical treatment for entero-urinary fistulas (EUFs) in Crohn's disease (CD) has so far been modest and surgery is the standard treatment. There are no studies that assess the outcomes of anti-TNF agents for treatment of EUFs. The aim of this study was to evaluate the effectiveness of anti-TNF therapy for inducing remission of EUF in CD patients and avoiding the need for surgery.
A retrospective search in prospectively maintained databases was performed for CD patients with EUF. EUFs were confirmed by surgery, radiological or endoscopic techniques. We defined remission as the absence of clinical symptoms with a radiological confirmation of EUF closure. Cox regression analysis was performed for predictive factors of achieving remission without need for surgery.
Of 6081 CD patients, 97 (1.6%; 95% CI 1.3–1.9) patients with EUF were identified. Mean (SD) age at diagnosis of EUF was 32 (14) and median disease duration was 22 months (IQR 6–90). At the last follow-up visit, 93 (96%) patients were in sustained remission (median follow-up from remission 91 months, IQR 39–147). A total of 79 patients required surgery, and in 74 (94%), surgery induced sustained remission (median follow-up 101 months, IQR 58–150). Forty-seven patients were treated with an immunomodulator, with 2 patients achieving sustained remission.
Thirty-three patients received anti-TNF therapy (21 infliximab, 9 adalimumab and 3 both). Of those 14 (42%) achieved sustained remission (median follow-up from remission 35 months, IQR 25–46) without needing surgery (10 with infliximab and 4 with adalimumab). A further 15 (45%) patients achieved sustained remission after surgery (median follow-up 59 months; IQR 26–74). Four patients were in partial response at the last follow-up visit and continued on anti-TNF therapy. Among the 64 patients who did not receive an anti-TNF agent, 61 (95%) needed surgery.
In the Cox analysis (adjusted for age, gender, disease duration and use of immunomodulator or antibiotics), the use of anti-TNF agents was associated with an increased rate of remission without need for surgery (HR 0.22, 95% CI 0.13–0.37; p < 0.001).
Anti-TNF therapy was effective for EUFs in CD, with 42% of patients achieving sustained remission without need for surgery. The use of anti-TNF agents was the only predictive factor associated with a reduction in the need for surgery. Therefore anti-TNF therapy seems to be a useful treatment for EUF in CD patients in whom the aim is to avoid surgery.