{
  "abstract": "Background Metastatic Cutaneous Crohn’s Disease (MCD) is a rare but significantly debilitating and poorly understood cutaneous extra-intestinal manifestation of Crohn’s disease. There are less than 650 cases reported worldwide, with almost no data to identify high risk groups or assess treatment outcomes and options. No formal treatment guidelines exist for this condition.Methods We conducted a retrospective and prospective multi-centre study for patients with a clinical and/or histological diagnosis of metastatic Crohn’s Disease managed at 2 tertiary referral centres in the United Kingdom. Demographics, disease characteristics, Crohn’s phenotype, surgical treatment, and sequencing and efficacy of biological medical therapy was recorded for each patient.Results We recorded data for 58 patients with MCD over a 25-year period. This represents the largest series in the published literature. 81% were female, with an average age of MCD diagnosis of 37.5. The average age at CD diagnosis was 25.7, reflecting the potential for these patients to present many years following a luminal CD diagnosis. The genitals, ­perineum and groins were the most affected sites. 62% had a colonic ­phenotype of CD, and 55% had a B1 inflammatory phenotype. There was an association with peri-anal CD (84%) but these were not all fistulising disease (64%). Anti-IL12/23 therapy was the most common currently prescribed biologic, followed by anti-TNF (26 and 24% respectively), but 83% of patients had been taking anti-TNF at some time. 14% of patients were taking JAK inhibitors. Many patients that started on anti-TNF and were required to switch, changed to a different anti-TNF (50%). However, 79% required a 3rd line agent, most of which was Anti-IL12/23 (50%). 29% required a 4th line agent and 10% were on a 5th line.70% of patients had a defunctioning stoma as part of their treatment. Nearly half had previously had a colonic resection prior to onset of MCD, with 28% having MCD in a previous proctectomy wound.Conclusion We summarise the clinical phenotype of the largest series of MCD patients in the published literature. MCD disproportionately affects younger females, with a colonic inflammatory CD phenotype. Concurrent pCD is common. Prior resectional surgery is common in MCD patients, and patients with a chronic non healing proctectomy wound should be evaluated for MCD. For treatment positioning, anti-TNF therapy is the most common and effective biologic, but many patients will require a switch of therapy. IL-12/23 followed and had a relatively good efficacy. JAK inhibitors have shown early promise in a small group.",
  "authors": [
    {
      "affiliations": [
        "Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom",
        "Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "David Leiberman"
    },
    {
      "affiliations": [
        "Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Tyler Chapman"
    },
    {
      "affiliations": [
        "Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom",
        "Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Deepak Selvakumar"
    },
    {
      "affiliations": [
        "Department of Dermatology, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Calum Lyon"
    },
    {
      "affiliations": [
        "Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom",
        "Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Sheena Cruickshank"
    },
    {
      "affiliations": [
        "Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom",
        "Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom",
        "Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "John McLaughlin"
    },
    {
      "affiliations": [
        "Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom",
        "Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Laura Hancock"
    }
  ],
  "title": "P229 Disease phenotyping and real-world treatment sequencing for metastatic cutaneous crohn’s disease (MCD)",
  "uid": "e34a48f6-137d-54a0-95ad-4341ce44f69c"
}