P2577 - Efficacy of Upadactinib in the Management of Perianal Disease in Patients With Crohn’s Disease

Tarek Odah, MD, Jami A. Kinnucan, MD, FACG, Michael F. Picco, PhD, MD, Jana G. Hashash, MD, MSc, Francis A. Farraye, MD, MSc
Mayo Clinic, Jacksonville, FL

Introduction: Perianal disease, particularly anal fistula, is a complication of Crohn’s disease (CD) and often necessitates a multidisciplinary treatment approach involving both medical and colorectal surgical interventions. Medical management for these patients typically begins with tumor necrosis factor (TNF) inhibitors. Upadacitinib, an oral Janus kinase inhibitor approved for CD treatment in the United States, represents a second-line therapeutic option. However, there are limited data on the use of upadacitinib in the management of patients with perianal CD. Therefore, this study aimed to evaluate the efficacy of upadacitinib for the management of perianal disease.

Methods: This retrospective study examined adult patients with perianal CD disease who were initiated on upadacitinib treatment before May 2024. We excluded 30 patients under 18 years of age, those with unconfirmed upadacitinib use, or those lost to follow-up. The primary outcome assessed was anal fistula improvement, defined as complete drainage resolution, improvement/resolution on MRI, or external closure of the fistula opening. Follow-up was defined as the time from upadacitinib initiation to initial improvement or provider-declared treatment failure.

Results: A total of 12 patients met the inclusion criteria. Following the initiation of upadacitinib for perianal fistula, 50% (6/12) of patients showed improvement. Table 1 shows the demographics, medical history, and perianal disease characteristics of the patients. Among patients with improvement, 4 experienced complete resolution of draining, 2 showed improvement on MRI, one achieved resolution on imaging, and one had external closure of the fistula opening. Of the patients with improved anal fistula, 66.7% were female, whereas those without improvement were exclusively male (p=0.06). All 6 patients without improvement had complex fistulas (6/6), whereas only 50% (3/6) of those showing improvement had complex fistulas (p=0.18). Meanwhile, 4 patients had concomitant abscesses in those who did not improve, and two had concomitant abscesses in the other group (p=0.57).

Discussion: Our small study suggests that upadacitinib may improve perianal disease in 50% of patients with CD. Non-improvement was observed more in males and in patients with complex anal fistulas, but the difference was not statistically significant. Larger studies are warranted to further evaluate the efficacy of upadacitinib in this challenging condition.


Disclosures:


Tarek Odah, MD, Jami A. Kinnucan, MD, FACG, Michael F. Picco, PhD, MD, Jana G. Hashash, MD, MSc, Francis A. Farraye, MD, MSc. P2577 - Efficacy of Upadactinib in the Management of Perianal Disease in Patients With Crohn’s Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.