P360 Adalimumab in perianal Crohn's disease treatment: Experience of a tertiary center
D. Carvalho*1, C. Bernardes1, P. Russo1, J. Saiote1, S. Nunes2, J. Ramos1
1Hospital Santo António dos Capuchos, Gastroenterology, Lisboa, Portugal, 2Hospital Santo António dos Capuchos, General Surgery, Lisboa, Portugal
Perianal Crohn's disease (PACD) represents a phenotype with severe prognosis and significant morbidity. In literature few studies describe adalimumab (ADA) efficacy in PACD, especially in terms of time to achieve response and its durability.
Consecutive patients with PACD treated with ADA were prospectively monitored to assess ADA efficacy, using Perianal Disease Activity Index (PDAI). Exam under anesthesia and/or magnetic resonance was performed in patients with complex perianal disease. Response was defined as a PDAI lower than 5 or a decrease in more than 5 points in PDAI. Remission was considered when PDA was lower than 3. Loss of response was defined by any increase in PDAI, by the recrudescence of draining fistulas, by the occurrence of any other perianal complication or the need for additional therapy
Fifteen patients were treated, 9 of which were women (60%). The median age was 34 years-old (19-71). Seven were smokers (46,7%) and 4 were previous smokers (26,7%). Montreal classification was as follow: L1 in 5, L2 in 5 and L3 in 5. Two patients showed extra-intestinal manifestations (erythema nodosum). Six patients were previously treated with infliximab (40%: 4 intolerants and 2 loss response); 8 were taking azathioprine concomitantly (53%) and one methotrexate. Indications for treatment were perianal ulcer in 2 and penetrating disease in 13 (6 after abscess drainage; 7 perianal fistulas - 2 anovaginal fistulas and one anoscrotal). At baseline 2 patients had PDAI ≤ 5, 7 between 6-8 and 6 between 9-11. At Week 2, response was achieved in 80% (remission in 46, 7%). At week 14, 86,7% responded (80% were in remission). Four patients did not respond or lost their response: two recovered (PDAI ≤ 2) with adalimumab administrated weekly, one was proposed to infliximab and one developed an abscess. Three did not have a complete follow-up: one failed to attend the appointments, one suspended ADA due to intolerance and other was a non-responder. At week 52, 12 patients completed follow-up: 7 with PDAI 0, PDAI between 1-3 in 4 and one with PDAI 6.
Conclusion: ADA was effective in PACD, inducing fast response and healing, remission in 80% at week 14 and maintenance of remission in 73% patients at week 52.