P1247 Medical and Surgical management of Crohn`s disease perianal fistula in LATAM countries: A multicentre cohort study

Abstract Background Studies report variable access to medical and surgical therapy options for Crohn’s disease related perianal fistula ( PF-CD) . There is limited data on the management approaches from LATAM countries . Methods This was a multicentre retrospective cohort study . We included patients diagnosed with PF-CD from 4 LATAM countries (Argentina, Chile, Colombia and Peru). Data was collected on medical therapy approaches including access to and use of antibiotics, steroids, biologics and small molecules following diagnosis of perianal fistula. Data on surgical interventions were recorded. A multicountry retrospective analysis was conducted in patients with PF-CD from Argentina (N = 75), Chile (N = 49), Colombia (N = 145), and Peru (N = 22). Data collected included medical and surgical therapies, use of biologics (infliximab, adalimumab, ustekinumab, vedolizumab), thiopurines, methotrexate, and emerging therapies. Fistula characteristics, including number of tracts, were also analysed. Results We included 291 patients with PF-CD (Argentina 75, Chile 49, Colombia 145, Peru 22). Multiple fistula tracts were reported in 16% of patients in Argentina, 42% in Chile, 16.6% in Colombia, and 18.2% in Peru. Anti-TNFs were the main advanced therapy (232 patients, 79.7%), with monotherapy rates of 76% in Argentina, 75% in Chile, 83% in Colombia, and 77.3% in Peru. Time from fistula diagnosis to anti-TNF initiation varied significantly (p < 0.01): Argentina 4 months, Chile 0, Colombia 6, Peru 1. Combination therapy (anti-TNF + antibiotics) was more common in Argentina (42.7%) and Chile (40.8%) than in Colombia (9%) and Peru (18.2%). Access to other biologics was limited: ustekinumab was used only in Argentina (18%); vedolizumab in Argentina (4%) and Colombia (0.7%); upadacitinib in Argentina (3 patients) and Chile (1). Thiopurine exposure differed widely (Argentina 33%, Chile 46.9%, Colombia 6.2%, Peru 90%). Methotrexate use was low across countries. Proctectomy occurred in 8% of patients in Argentina, 2% in Chile, none in Colombia, and 9.1% in Peru (overall 3%). Conclusion There are variations in treatment patterns in CD-PF in LATAM compared to data from western world and also among LATAM countries. There are variable delays in initiation of first line biologics and there is limited use of combination multimodal therapy. Access to non- antiTNF biologics and small molecules is sparse. These findings highlight a substantial gap between recommended international standards and real-world practice in the region. Conflict of interest: Pavez, Carolina: No conflict of interest Juliao Baños, Fabián: No conflict of interest Balderramo, Domingo Cesar: No conflict of interest Cedron Cheng, Hugo Guillermo: No conflict of interest Hernandez-Rocha, Cristian: No conflict of interest Parra Izquierdo, Leidy Viviana: No conflict of interest Osorio, Laura: No conflict of interest Gil Parada, Fabio Leonel: No conflict of interest Puentes-Manosalva, Fabian: No conflict of interest Pizarro, Paula A.: No conflict of interest Etchevers, Maria Josefina: No conflict of interest Sobrero, Maria Josefina: No conflict of interest Sanchez, Maria Belen: No conflict of interest Montero, Joaquin: No conflict of interest Gil, Anibal Hector: No conflict of interest Sambuelli, Alicia: No conflict of interest Balaban, Ezequiel: No conflict of interest Rohwain, María José: No conflict of interest Alvarez-lobos, Manuel: No conflict of interest Bellolio, Felipe: No conflict of interest Sepúlveda, Ignacia: No conflict of interest Hernandez, Elisa: No conflict of interest Pérez, Tamara: No conflict of interest Estay, Camila: No conflict of interest Rojas, René: No conflict of interest Sepulveda, Rolando: No conflict of interest Perez Alfaro, Ignacio: No conflict of interest Paredes Mendez, Juan: No conflict of interest Cervera Caballero, Luis: No conflict of interest Sebastian, Shaji: No conflict of interest Catalàn-Serra, Ignacio: No conflict of interest