P650 Combination therapy for perianal fistulising Crohn's disease in biological era: What is the optimal time for surgical intervention?. (16th January 2018)

• Record Type: Journal Article
• Authors: Zhu, P; Yang, B L
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S439
• Page End: S440
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.777
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Management of complex perianal fistulising Crohn's disease (pCD) continues to be challenging. Recent studies have recognised that combined surgery and anti-TNFa therapy could improve clinical outcomes in patients with pCD. However, the optimal timing of surgical intervention after infliximab infusion is still controversial. The aim of the present study was to determine the long-term efficacy of the treatment strategy with early surgical intervention based on infliximab therapy for pCD. Methods: In this retrospective cohort study, consecutive patients seen at Affiliated Hospital of Nanjing University of Chinese Medicine, which received combined infliximab and surgical treatment between July 2010 and January 2017 for active pCD were included. Patients received surgical intervention during the induction infliximab therapy (time interval < 6 weeks) were grouped into the do-not-wait (DNW) cohort, while with time interval >6 weeks were grouped into the do-wait (DW) cohort. The long-term recurrence rate was compared using Kaplan–Meier curves and log-rank tests. Cox proportion hazard model was used to identify risk factors for the development of recurrence in DNW cohort. Results: One hundred and seventeen patients were included and followed-up for a median of 36.0 (IQR 23.5–58.5) months. Among them, 73 patients and 44 patients were grouped into DNW cohort and DW cohort, respectively. There was no significant difference in baseline characteristics between two cohorts. The median interval between surgery and initial infliximab infusion was 9.0 (IQR 5.5–17.0) days in DNW cohort and 188.0 (IQR 102.25–455.75) days in DW group. Greater percentages of patients in the DNW cohort had anorectal stenosis compared with patients in the DW cohort (37% vs. 20.5%, p = 0.061). At the end of follow-up, 61.6% of patients in DNW group and 65.9% patients in DW group derived clinical remission respectively ( p = 0.643). The cumulative recurrence rate after perianal surgery was 23%, 32%, 35% in DNW group and 16%, 24%, 24% in DW group, at 1, 2, and 3 years, respectively ( p = 0.162). In DNW cohort, the presence of concurrent abscess at baseline (HR: 3.802; 95% CI 1.413–10.229; p = 0.008) and maintenance infliximab therapy >3 infusions (HR: 2.356; 95% CI 1.012–5.488; p = 0. 047) predicted the development of recurrence. Conclusions: Based on infliximab therapy, early surgical intervention could provide long-term benefits for pCD. The presence of concurrent abscess and maintenance infliximab therapy more than three times were risk factors for recurrence with early surgical intervention.