P68 Management of metastatic cutaneous crohn`s disease using ustekinumab: a single centre study

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Introduction Metastatic Crohn’s disease (MCD), also known as cutaneous Crohn’s disease is one of the rarest cutaneous lesions in IBD. It is defined by granulomatous lesions infiltrating the skin that are discontinuous from the affected GI tract. In most occasions, MCD occurs parallel to the course of a well-establish GI disease, but occasionally it can precede the GI manifestations from months to years. Studies addressing the therapeutic approach to MCD are limited. Ustekinumab is licenced for Crohn`s disease and also for skin disorders including psoriasis. We report our experience in managing MCD in a tertiary IBD centre Methods This is a single centre retrospective review of biopsy proven cutaneous Crohn’s disease. Patient details obtained from patient records included demographic data, previous failure to biologics and/or IMS, response and time to response to Ustekinumab and therapeutic drug monitoring. Results A retrospective review of patients with cutaneous Crohn’s disease was performed. All patients had undergone a skin biopsy for histologically confirmation. Ten patients were included (Males: Females 5:5). Median age was 53 years (IQR 24–67). The most common location was the perianal area often preceded by a surgical wound from a proctectomy and 2 patients had peristomal skin affected. Ninety- percent of patients had failed antiTNF therapy and 6 out of 10 had failed to both Infliximab and Adalimumab, one of them had also lost response to Vedolizumab. All patients received ustekinumab with median follow up since initiation of 45 months (IQR 27–60). All patients noticed improvement since initiation of Ustekinumab with a median time to response of 10 weeks (IQR 4–28). Four out of 10 patients achieved a complete healing of the skin lesions (see example picture shared with patient’s consent) while rest of patients reported a partial response. Most patients had therapeutic or supratherapeutic Ustekinumab level ranging from 2 to 6 mg/L. Dose escalation was done in 8 patients. Conclusions Metastatic Crohn’s disease is a rather uncommon entity with different clinical manifestations. Our series report satisfactory response to ustekinumab in MCD. Larger studies are required to confirm these findings.

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