P0731 Analysis of the short-term efficacy and risk factors of ustekinumab combined with surgical intervention in the management of perianal fistulizing Crohn's Disease: a single center real-world result
K Ma, Y Li, F Weng, Y Yao, C WangAbstract
Background
The aim of this study was to evaluate the short-term clinical efficacy and identify potential risk factors for Ustekinumab (UST) in conjunction with surgical intervention among patients diagnosed with perianal fistulizing Crohn's Disease (pfCD), utilizing MRI healing as the gold standard.
Methods
The study was conducted retrospectively from July 2021 to July 2024, including all patients diagnosed with pfCD who underwent surgical intervention combined with UST treatment and completed a 24-week follow-up. The clinical data of patients and perianal fistula characteristics, were collected. The primary efficacy evaluation indicator is the clinical healing rate and MRI healing rate after treatment. The secondary efficacy indicators included the CDAI, PDAI, CRP, ESR, and FC. Additionally, the SES-CD and Van Assche score were utilized, along with Wexner incontinent score, to evaluate effectiveness prior to treatment and at 24 weeks post-treatment. The independent risk factors induced MRI healing after treatment were determined through multivariate analysis using binary logistic regression analysis.
Results
A total of 66 patients were included in this study. According to the Montreal classification, group A1, A2 and A3 consisted of 3 patients (4.5%), 59 patients (89.4%), and 4 patients (6.1%) respectively. In terms of disease location, 26 patients (39.4%) were classified as L1, 9 patients (13.6%) as L2, and 31 patients (47.0%) as L3. Additionally, 50 patients (75.8%) presented with B1 while the remaining 16 patients (24.2%) had B2. Four patients (6.1%) presented with simple anal fistulas, while complex anal fistulas were observed in 62 cases (93.9%). At 24-week follow-up, the clinical healing rate was 95.5% (63/66) with an average healing time of 8.58 ± 4.27 weeks. The MRI healing rate demonstrated a significant outcome of 68.2% (45/66). Additionally, there was a notable reduction in patients' CDAI and PDAI scores, as well as CRP, ESR, FC concentrations, Van Assche scores, SES-CD and Wexner scores at 24-week compared to baseline levels (p < 0.001). The multivariate logistic regression analysis revealed that the presence of perianal abscess (OR = 0.05, 95%CI: 0.004~0.052, p = 0.014) and a high baseline Van Assche score (OR = 0.48, 95%CI: 0.252~0.901, p = 0.023) were identified as independent risk factors for MRI healing in patients with pfCD. Meanwhile, no instances of anal function problems were reported during the follow-up period.
Conclusion
The combination of UST and surgical intervention demonstrates favorable short-term clinical efficacy and safety in the management of patients with pfCD. Notably, the presence of perianal abscess and a high Van Assche score independently contribute to the risk of incomplete MRI healing.