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IntroductionTreatment paradigms for Crohn’s disease with perianal fistula (CD-PAF) are still evolving and so far, considered to have disappointing rates of complete healing. We aimed to study the impact of multidisciplinary multimodality treatment approach in CD-PAF on the recurrence rates of fistula and need for re-interventions.MethodThis was a multinational multicentre retrospective cohort study with data collected in CD patients who developed fistula from 2010 to 2015. Multidisciplinary multimodality approach was defined as using a combination of medical treatments (antibiotics, immunomodulators, and biologics) along with surgical approach (examination under anaesthesia (EUA) +/- Seton drainage) at diagnosis.Results253 adult onset CD-PAF patients were included. There was significant difference in fistula healing rates between simple and complex fistulae (complete healing 60% vs 41%, p=0.015). 52% of patients who received multimodality treatment had complete fistula healing. 27% of simple fistula and 40.3% of the complex patients had recurrent fistula needing re-intervention at a median of 12 months (range 1–36 months) from diagnosis of fistula. 22% of those with complete healing needed repeat surgery compared to 49% with partial healing and 71% in those with no healing (p=<0.001). Only 26% of the 141 patients having multidisciplinary multimodal treatment needed surgical re-intervention when compared to 59% without this( P=<0.001).Univariate analysis showed complex (p=0.008),absence of multidisciplinary approach (p=<0.001), EUA (p=0.005),combined immunosuppression (p=0.032),presence of proctitis (p=<0.001) as factors impacting need for re-intervention but there was no impact of age, gender, smoking status, mode of presentation,Montreal class, presence of anal stenosis and thiopurine use alone. On logistic regression, absence of multi-disciplinary approach (OR 2.8, 95% CI: 1.4–5.6) and presence of proctitis OR 2.2, 95% CI: 1.2, 3.9) were predictors for re-intervention.ConclusionIn this multicentre cohort study, complete fistula healing rates were higher and the recurrence rates lower than previously reported. Presence of proctitis and lack of multidisciplinary approach are predictors for recurrence and re-intervention for CD-PAF.Disclosure of InterestNone Declared

Background The development program (UNIFI) has shown promising results of ustekinumab in ulcerative colitis (UC) treatment that should be confirmed in clinical practice. Aims Primary: to evaluate the durability of ustekinumab treatment in UC patients in clinical practice. Secondary: to assess the short-term response (at week 16) and the long-term effectiveness (at maximum follow-up) and to assess the safety of ustekinumab in clinical practice. Methods Patients included in the prospectively maintained ENEIDA registry who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score (PMS) &gt;2] were included. Clinical activity and effectiveness were defined based on PMS. Results 95 patients were included (table 1). At week 16, 53% of patients had clinical response (including 35% of patients in remission) (figure 1). In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with clinical remission. Long-term remission is represented in figure 2. 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at week 16, 63% at week 56, and 59% at week 72 (figure 3); primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. Conclusion Ustekinumab is effective both in the short and the long-term in real-life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.

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