P461 Clinical benefit of adalimumab after surgery in the treatment of complex perianal Crohn’s disease: a tertiary referral centre experience
G. Solina*1, S. Renna2, E. Orlando2, M. Affronti2, M. Cottone2, A. Orlando2
1’Villa Sofia-V. Cervello’ Hospital, Division of Surgery, Palermo, Italy, 2’Villa Sofia-Cervello’ Hospital, Division of Internal Medicine, Palermo, Italy
The management of perianal of Crohn’s disease (CD) is difficult and needs a multidisciplinary approach, with cooperation amongst gastroenterologist and colorectal surgeon. Anti-TNFα therapy is the most effective medical strategy for this condition, but data regarding the effectiveness of adalimumab (ADA) in this setting are limited. We report the experience of a multidisciplinary team in the management of complex perianal CD treated with ADA after surgery
Patients (pts) with CD and complex perianal fistulae were included. They were first evaluated with clinical examination, and then with under anaesthesia surgical inspection. All septic sites were drained, and loose setons were inserted. Setons were removed if perianal infection was resolved and after starting ADA. According with the ‘Fistula Drainage Assessment Index’, clinical improvement was defined as a decrease from baseline in the number of open draining fistulae of 50% for at least 2 consecutive visits (at least 4 weeks), and clinical remission as closure of all fistulae that were draining at baseline for at least 2 consecutive visits (at least 4 weeks).
In total, 58 patients (pts) with complex perianal CD were prospectively included in the study. All pts started ADA after seton position and according with surgeon evaluation. After 12 months from seton discharge, 43/58 pts (74%) obtained a clinical benefit continuing ADA at the dosage of 40 mg eowk (57% remission and 17% improvement). In addition, 7 pts (12%) did not obtained clinical benefit within 6 months and discontinued ADA: 4 underwent stoma, and 3 changed medical treatment after dose escalation. In 8 pts, loose setons were not yet removed. No adverse effects were reported.
Our experience shows that a multidisciplinary management is the best approach in the treatment of perianal CD. Surgery was confirmed to be the mandatory first approach and ADA was confirmed to be effective to obtain fistula closure after 12 months of treatment.