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P536. Effectiveness of the available therapeutic options in the treatment of perianal fistulas in patients with Crohn's disease (CD)

B. Arberas-Diez1, M. Chaparro1, P. Burgueño1, I. Vera2, F. Bermejo3, I. Marín-Jiménez4, C. Yela5, P. López6, M.D. Martín7, C. Taxonera8, B. Botella9, R. Pajares10, A. Ponferrada11, M. Calvo2, A. Algaba3, L. Pérez4, B. Casis5, J. Maté1, J.P. Gisbert1, 1Hospital Universitario de La Princesa, IP, Gastroenterology and CIBEREHD, Madrid, Spain, 2Hospital Universitario Puerta de Hierro Majadahonda, Gastroenterology, Madrid, Spain, 3Hospital Universitario de Fuenlabrada, Gastroenterology, Madrid, Spain, 4Hospital Universitario Gregorio Marañón, Gastroenterology, Madrid, Spain, 5Hospital Universitario 12 de Octubre, Gastroenterology, Madrid, Spain, 6Hospital Universitario Fundación Alcorcón, Gastroenterology, Madrid, Spain, 7Hospital Universitario La Paz, Gastroenterology, Madrid, South Korea, 8Hospital Universitario Clínico San Carlos, Gastroenterology, Madrid, Spain, 9Hospital Universitario Infanta Cristina, Gastroenterology, Madrid, Spain, 10Hospital Universitario Infanta Sofia, Gastroenterology, Madrid, Spain, 11Hospital Unviersitario Infanta Leonor, Gastroenterology, Madrid, Spain

Background

25% of CD patients develop perianal fistula during follow-up. There are few studies comparing the effectiveness of the available therapeutic options.

Aim: To 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. The effectiveness was evaluated considering the first attempt with each treatment.

Results

313 CD patients with perianal fistula were included (mean age 41 years, 55% male). In 80% of the patients the perianal fistula was complex, and in 20% simple. 62% of the patients had received antibiotics, 71% thiopurines, 54% anti-TNFs and 66% had undergone surgery. The most commonly used antibiotic regimen was the combination of ciprofloxacin and metronidazole. 41% of the patients had a complete response (62% simple vs. 37% complex). The response was similar with the different antibiotics. Ciprofloxacin was the best tolerated. Among patients treated with thiopurines, 37% had completed response (66% simple vs. 32% complex, p = 0.002). The rate of complete response in patients with complex fistulas was similar between patients treated with thiopurines in monotherapy and with antibiotic plus thiopurines (33% vs. 11%, p = 0.37). In patients treated with anti-TNFs (93% infliximab and 7% adalimumab), 92% had a response (63% complete and 29% partial). When anti-TNFs had been administered as the 1st line treatment, the rate of complete response was higher with the combination with thiopurines than with anti-TNFs in monotherapy (77% vs. 59%, p = 0.03). The most common surgical intervention was fistulotomy (37%), followed by placement of setons (32%). 54% of patients had complete response (81% simple vs. 50% complex, p = 0.009). The recurrence rate of fistulas with each treatment was: 66% with antibiotics, 46% with thiopurines, 36% with anti-TNF and 51% with surgical intervention. The treatment had to be stopped due to adverse events in 3.4% of patients under antibiotics, 14% with thiopurines and 12% with anti-TNFs.

Conclusion

Combined treatment with thiopurines and anti-TNF drugs is more effective than anti-TNFs in monotherapy for CD perianal fistula. The effectiveness is limited and the recurrence high.