S1655 A Multicenter Study of the Efficacy of Risankizumab in Perianal Crohn’s Disease: A Real-World Experience

Introduction: Perianal (PA) disease can affect about 25-35% of patients with Crohn’s disease (CD). PA CD has been associated with higher rates of hospitalization, surgical intervention, and decreased quality of life. Risankizumab (RZA) is approved for the treatment of moderate to severe CD, however there is limited data on its efficacy for the treatment of PA CD. In this multicenter study, we sought to describe the efficacy of RZA in patients with PA CD. Methods: We conducted a retrospective review of electronic health records from 2 academic hospitals to identify adult patients with PA CD on RZA therapy who had failed prior anti-TNF therapy. PA disease was defined as perianal fistula or abscess. We collected the patient’s demographics, CD and prior treatment history, and C-reactive protein (CRP) levels prior and during RZA therapy. PA disease response while on RZA was defined as clinical documentation of >50% reduction in drainage and number of fistulas from baseline. Results: We identified 134 patients with PA CD on RZA, and 90 patients met inclusion criteria. Of those, 25 had active PA disease at the time of RZA initiation (avg age 40.2 yrs [SD 13.9 yrs]; 64% male; mean CD duration 21 yrs [range 4-50 yrs]; 92% had been on at least 2 biologics). 84% underwent prior PA procedures, with 48% having at least 2 prior procedures. At 3 months of therapy, 48% had a fistula response. At 12 months, 36% had a response. Patients had a baseline median CRP of 1.1 mg/dL (IQR 0.4-24). At 12 months, median CRP was 0.4 mg/dL (IQR 0.26-1.97). By 12 months, 24% received antibiotics and 8% required surgery for PA disease. Those with fistula response at 6 months had an average total duration on RZA of 1.41 yrs (SD 0.76 yrs). Those with no response were on average 1.68 years (SD 0.66 yrs). In the inactive group of 63 patients, 3 had recurrence of PA disease, and 1 had a PA procedure by 12 months. Conclusion: In this cohort of anti-TNF refractory PA CD patients on RZA, the majority of patients with inactive PA disease remained disease-free and without antibiotics at 12 months of RZA therapy. In those with active PA, about 36% had a fistula response at 12 months of therapy, but 76% were not on antibiotics and 92% did not require surgery for PA disease. This study suggests a role for RZA in patients with PA CD in a real-world setting. We aim to expand upon these findings in a larger cohort of patients.