P388 Fistula Healing in Perianal Crohn's Disease - With or Without Anti-TNF Therapy?
N.A. Yassin*1, A. Askari2, L. Ferrari2, O. Faiz2, J. Warusavitarne2, R. Phillips2, A. Hart3
1St Mark's Hospital, Colorectal Surgery & IBD Unit, London, United Kingdom, 2St Mark's Hospital, Colorectal Surgery, London, United Kingdom, 3St Mark's Hospital, IBD Unit, London, United Kingdom
Anti-tumor necrosis factor (TNF) therapies are used to treat fistulising perianal Crohn's disease (CD). We evaluated the clinical and radiological outcomes of patients with perianal Crohn's fistulas in the pre-anti-TNF and in the post-anti-TNF era.
A local database of 270 consecutive patients with CD treated at our institution between 2000 and 2014 was established.
Ninety patients were in the non-anti-TNF group and 180 were treated with anti-TNF therapy (Infliximab or Adalimumab). Clinical response rates were significantly higher in the anti-TNF group (74% vs 62%, p=0.04). Similarly, radiological response rates were higher in the anti-TNF group (56% vs 28%, p<0.01).
Cox Regression analysis demonstrated fistula duration (p=0.01) and biologic therapy (p=<0.01) to be significant at the univariate level. At the multivariate level, patients on anti-TNF therapy had a faster radiological response over a 6-year follow-up period (OR=2.25, CI= 1.14-4.46, p=0.02). A short duration of CD (less than 5 years) contributes to a faster time to clinical response (OR=1.77, CI=1.03-3.05, p=0.04).
Treatment with anti-TNF therapy is an independent predictor of radiological response (OR 3.55, CI 1.59-7.91, p<0.01). Patients with L1 luminal disease are 3 times more likely not to go into clinical remission on both univaraite and multivariate analyses (OR=3.08, CI=1.47-6.46, p=0.01). The duration of CD is also a poor predictor of clinical response to therapy (p<0.01).
Patients on anti-TNF therapy have improved clinical and radiological response rates compared with patients without. Anti-TNF therapy is a positive predictor of radiological response to therapy.