P627 Stopping anti-tumour necrosis factor (TNF) therapy in patients with perianal Crohn’s disease: Results from a population-based study
W. Y. Mak*1, W. Tang1, F. K. L. Chan1, W. K. Leung2, M. K. K. Li3, F. H. Lo4, C. K. M. Ng5, A. S. F. Sze6, C. M. Leung7, S. W. C. Tsang8, E. H. S. Shan9, K. H. Chan10, B. C. Y. Lam11, A. J. Hui12, W. H. Chow13, J. J. Y. Sung1, S. C. Ng1
1The Chinese University of Hong Kong, Medicine and Therapeutics, Hong Kong, Hong Kong, 2The University of Hong Kong, Medicine, Hong Kong, Hong Kong, 3Tuen Mun Hospital, Medicine and Geriatrics, Hong Kong, Hong Kong, 4United Christian Hospital, Medicine and Geriatrics, Hong Kong, Hong Kong, 5Princess Margaret Hospital, Medicine and Geriatrics, Hong Kong, Hong Kong, 6Queen Elizabeth Hospital, Medicine, Hong Kong, Hong Kong, 7Pamela Youde Nethersole Eastern Hospital, Medicine, Hong Kong, Hong Kong, 8Tseung Kwan O Hospital, Medicine, Hong Kong, Hong Kong, 9Caritas Medical Centre, Medicine and Geriatrics, Hong Kong, Hong Kong, 10North District Hospital, Medicine, Hong Kong, Hong Kong, 11Kwong Wah Hospital, Medicine and Geriatrics, Hong Kong, Hong Kong, 12Alice Ho Miu Ling Nethersole Hospital, Medicine and Therapeutics, Hong Kong, Hong Kong, 13Yan Chai Hospital, Medicine, Hong Kong, Hong Kong
Background
Little is known of the outcome of patients with perianal Crohn’s disease (PCD) after stopping anti-TNF. Aim: To assess rate of relapse in PCD patients after stopping anti-TNF.
Methods
Consecutive PCD patients treated with anti-TNF therapies were identified from a territory wide Hong Kong IBD registry which covers 13 public hospitals in Hong Kong. Patients’ disease characteristics, drug therapies and clinical outcomes were retrospectively reviewed from medical records and analysed.
Results
Sixty-three PCD patients received anti-TNF from 1997 to 2016. Median age at PCD diagnosis was 24 years (interquartile range, IQR: 20–28) and 72% were male. Median follow-up was 10 years (IQR: 6.3–14.5 years). Fifty-nine patients had complex fistulas. All had thiopurines in addition to anti-TNF. Twenty-seven patients (42.9%) achieved clinical remission, defined as complete cessation of fistula drainage, after median of 6 months (IQR: 4–10 months). Ten (15.9%) achieved radiological healing, defined as complete resolution of previous high signal tract or subtle, narrow calibre intermediate signal tract. Radiological healing lagged behind clinical healing by median of 7 months (IQR, 3–10 months). Thirty-eight patients (60%) stopped anti-TNF after median duration of 13 months (IQR: 4–24 months). Reasons for stopping included: financial reason (
Conclusion
More than half of PCD patients developed relapse after stopping anti-TNF. Majority regained response after restarting anti-TNF. Larger and longer-term studies are needed to investigate the role of deep fistula healing and de-escalating therapy in PCD.