S76 Abstracts of the 20 th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144 mumab (ADA) for IBD treatment led to a contemporary rise of side effects reports, which some authors have defined “paradoxical”. This is the case of the onset of psoriatic lesions in anti-TNF-α treated IBD patients, whose pathogenetic mechanisms is not still clearly understood. Material and methods: We performed a pathogenetic review and a retrospec- tive analysis of anti-TNF-α treated IBD patients in our Center from May 2010 until May 2013, searching for new-onset psoriasis. Results: We identified 58 patients, 44 treated with ADA and 14 with IFX, finding out 6 cases of induced-psoriasis (prevalence 10%, Fig. 1). Histology showed extensive parakeratosis and lymphocytes infiltration (Fig. 2), con- firmed by immunostaining for CD3 (Fig. 3). Median age was 37,5 and males predominated. All psoriatic patients were treated with ADA (160/80/40 eow), no one had a prior history of psoriasis and only 2 had been already exposed to IFX. We observed 3 retroauricular and scalp psoriasis, 2 of which responder to topical therapy (vitamin D analogues/corticosteroid) without stopping ADA. The third case was switched to methotrexate because of enteropathic arthropa- thy, with complete resolution of skin lesions. Topical therapy was associated to systemic steroids obtaining complete response in one case, while in the other 2 patients ADA was stopped, because of a severe palmoplantar psoriasis and of worsened of life quality due (itch, pain, bleeding, Fig. 4). Conclusions: The appearance of psoriatic lesions in antiTNFalpha-treated patients may cause at first some confusion, insomuch that many authors have defined it “paradoxical”. The suspension of biologics should take into account patient quality of life and lesions extension, since it can cause chronic pain and discomfort. As reported in literature, the imbalance between TNFalpha and IFNalpha on one hand and the activation of Th17 cells by blocking TNF pathway on the other hand could explain the onset of psoriasis using biologics, an event that is no longer to be considered “paradoxical”, but an expected side effect in subjects with underlying immune alterations. P.06.18 A MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF PERIANAL CROHN’S DISEASE: A TERTIARY REFERRAL CENTRE EXPERIENCE G. Solina *,1 , S. Renna 1 , F. Mocciaro 2 , M. Olivo 1 , M. Cottone 1 , A. Orlando 1 1 Ospedali Riuniti “Villa Sofia-Cervello”, Palermo, Italy; 2 Ospedale Civico ARNAS, Palermo, Italy Background and aim: Perianal disease affects up to 30% of patients (pts) with Crohn’s disease (CD). The management of perianal disease is difficult and needs a multidisciplinary approach with cooperation among gastroenterologist and colorectal surgeon. We report the experience of a multidisciplinary team in the management of perianal CD. Material and methods: Pts with CD and complex perianal fistulae were in- cluded. Pts were first evaluated with clinical examination, magnetic resonance imaging and then with under anesthesia surgical inspection. All septic sites were drained and loose setons were inserted. Setons were then removed if pe- rianal infection was resolved and after starting medical treatment. We defined complete clinical response as the closure of all external openings and cessation of fistula drainage, evaluated with anal inspection and strong digital pressure. Results: Seventy pts were included. A total of 251 surgical procedures were performed and 107 fistulae were treated. In all but 18 pts 4 or less surgical procedures were required to remove perianal infection. In 15 pts surgical treatment is ongoing. After the last operation 37/55 pts were treated with biologics (33 adalimumab and 4 infliximab), 4/55 pts with azathioprine (AZA) and 14/55 pts with mesalamine. After a mean follow up of 38.5 months [5–108] 38/55 (69%) pts achieved complete fistula closure. In the group treated with biologics 25/37 (67.5%) pts had a complete fistula closure. In the group treated with AZA all pts achieved a complete fistula closure and in 9/14 (64.2%) pts treated with mesalamine a complete fistula closure was observed. Conclusions: Our experience show that a multidisciplinary management is the best approach in the treatment of perianal CD. Surgery was confirmed to be the mandatory first approach. Biologics resulted to be an effective medical treatment after surgery. Data on the efficacy of AZA and mesalamine, considered the small sample size, did not allow to draw any conclusion. P.06.19 LONG TERM ADALIMUMAB EFFICACY IN STEROID-DEPENDENT CROHN’S DISEASE PATIENTS A. Orlando *,1 , S. Renna 1 , F. Mocciaro 2 , M. Cappello 3 , I. Bravatà 3 , R. Di Mitri 2 , A. Craxì 3 , M. Cottone 1 1 Ospedali Riuniti “Villa Sofia-Cervello”, Palermo, Italy; 2 Ospedale Civico ARNAS, Palermo, Italy; 3 Policlinico Universitario, Palermo, Italy Background and aim: Adalimumab (ADA) is effective in the induction of steroid-free remission in patients (pts) with steroid-dependent Crohn’s disease (CD). We have already reported data on efficacy and prognostic factors of response to ADA in 110 steroid-dependent pts. At week 6, 91% of pts have had a clinical benefit (remission: 45.5%, response: 45.5%). At the end of the follow-up (mean 14.6 months), 80.9% of responders have maintained clinical benefit (remission: 64.5%, response: 16.4%). Only higher induction regimen was related to remission at week 6. Material and methods: All the 110 pts were followed up for a further 24 months and the following variables were evaluated at the end of the follow up: maintenance of clinical benefit, ADA discontinuation, mucosal healing, dosage escalation, surgical treatment. Results: At the end of the follow up (mean 38.6±8.6 months) 54 pts (49%) were still in maintaining treatment with ADA with clinical benefit, 56 pts stopped treatment because of ineffectiveness (35), side effects (15) or mucosal healing (6). Among no responders 16 pts were then treated with infliximab and 11 of them had a clinical response. During the follow up 26 pts received a rein- duction with 160/80 mg of ADA because of lack of efficacy and 50% had a clin- ical remission. Twenty-eight pts received a weekly mainteining treatment at the dosage of 40 mg and 50% had a clinical remission. Mucosal healing were re- ported in 15 of 60 pts who underwent colonoscopy (25%). At the end of the fol- low up 19 pts were operated on. At univariable analysis higher induction regi- men was not related with maintaining clinical remission (P=0.06, OR 2.01 95% CI: 0.944–4.266) but it was associated with a lower risk of surgery (P=0.04, OR 0.311 95% CI: 0.969–0.998). At the end of follow-up 15 pts (13.6%) developed side effects that determined discontinuation of the treatment. Conclusions: Half of the steroid dependent CD pts treated with ADA main- tained a clinical benefit after a mean follow up of about 3 years and 25% of them obtained a mucosal healing, without high risk of side effects. The higher induction regimen (160/80 mg) was confirmed to be the best strategy to maintain a long term efficacy of ADA avoiding surgery. In case of lack of efficacy a new induction dosage or a weekly maintaining treatment are to consider a therapeutic option before discontinuing ADA.