Abstract Background Data on the characteristics and management of perianal Crohn’s disease (PACD) from the Middle East and Africa (MEA) are scarce. The iGONDOMAR study is a global multicenter retrospective study designed to define the goals, needs, and outcomes for this population, with established global cohorts. We present a preliminary descriptive analysis of the baseline phenotype and advanced therapy (AT) sequencing from the initial MEA cohort. Methods A descriptive analysis was performed on the initial 53 patients with PACD enrolled in the iGONDOMAR MEA registry. Data on demographics, Montreal classification, fistula presentation timing relative to Crohn’s disease (CD) diagnosis, and the sequencing of AT (anti-TNF, non-anti-TNF, and JAK inhibitors) were extracted and summarized using descriptive statistics. Results From the initial cohort of 53 patients, the median age at CD diagnosis was 26 years (IQR: 18-33) and at fistula diagnosis was 27 years (IQR: 19-33). The dominant phenotype was ileocolonic (L3, 64%) and non-stricturing, non-penetrating (B1, 58%), though 23% had penetrating (B3) disease. A key finding was that a majority of patients (53%, n = 28) were diagnosed with CD and fistula simultaneously, while 25% (n = 13) presented with fistula first. 66% (n = 35) of patients had simple fistulae. At fistula diagnosis, 56% (n = 30) were on or newly starting an anti-TNF, with infliximab being the most common (75% of anti-TNFs, n = 24), typically at 5mg/kg (88%) and with a high rate of concomitant immunomodulator use (77%). Anti-TNF therapy was the dominant first-line AT (90% of those treated), comprising infliximab (68%) and adalimumab (22%). A clear shift was observed for second-line therapy, with ustekinumab (43%, n = 10) being the most common choice. The treatment burden was high, with 43% of patients (n = 22) requiring two or more lines of AT, and 26% (n = 14) requiring three or more. One patient (1.9%) in this cohort required a diverting ostomy, though no patients underwent proctectomy. Conclusion This preliminary analysis of the iGONDOMAR MEA cohort reveals that PACD in this region frequently presents concurrently with the initial CD diagnosis. Treatment patterns show a strong reliance on first-line infliximab with immunomodulation, followed by a high rate of switching to non-TNF biologics. These initial findings highlight a significant treatment burden and will be expanded by data from the wider global iGONDOMAR consortium. Future analyses will report on key long-term outcomes, including rates of complete and partial clinical and radiological fistula healing, re-intervention rates, multimodal therapy use, and the need for definitive surgical interventions such as diversion or proctectomy. Conflict of interest: Quraishi, Mohammed Nabil: Received speaker fees from Johnson and Johnson, Takeda, Abbvie, Hikma and Lilly and consultancy fees from Johnson and Johnson and Lilly. Ahmed, Hosameldin Abdelrahman: No conflicts of interest Salem, Osama Ebada: No relevant conflicts of interests Maher, Maha: No relevant conflicts of interests Afifi, Ahmed: No relevant conflicts of interests Youssef, Khaled Hamdy: No relevant conflicts of interests El-Atrebi, Kamal El-Deen Abdel rahman: No relevant conflicts of interests Mogawer, Mohamed: No relevant conflicts of interests Alboraie, Mohamed: Speaker/ advisory board/ consultancy: Janssen, Takeda, Sandoz, hikma, abbvie. Alahmad, Maryam: No relevant conflicts of interests Al-Bawardy, Badr: Speaker fees: AbbVie, Takeda, Bristol-Myers Squibb, Eli Lilly Hikma, Janssen Pharmaceuticals. Advisory board: AbbVie, Bristol-Myers Squibb, Eli Lilly, Pfizer, Janssen. Sebastian, Shaji: Grant: Takeda, Tillots pharma, Biogen, Pfizer, Abbvie, Johnson & Johnson, Olympus - Odin Vision Personal Fees: Tillots, Johnson & Johnson, Olympus Odin Vision, AbbVie, Takeda, Merck, Pharmacosmos, Amgen, Eli Lilly, BMS, Odin Vision Non-financial Support: Tillots, Takeda, AbbVie, Celltrion, Johnson & Johnson, Eli Lilly, Alphasigma, Ferring Pharma
Quraishi et al. (Thu,) studied this question.