P0535Overweight, unemployment and work absence are associated with reduced quality of life in patients with perianal fistulizing Crohn’s disease

Abstract Background Quality of life is an important treatment outcome measure in perianal fistulizing Crohn’s disease (pCD), as healing rates remain low. Identifying determinants of impaired health-related quality of life (HRQoL) may support more patient-centered care. This study aimed to explore these determinants in patients with active pCD. Methods Patients with active pCD were included in a prospective national cohort performed in 41 Dutch academic and non-academic hospitals between September 2022 and March 2023. For this study, patients who completed the validated disease-specific Crohn’s Anal Fistula-Quality of Life (CAF-QoL) scale and EuroQoL-5 Dimension-5 Level (EQ-5D-5L) questionnaire, at baseline, 3, 6 or 12 months follow-up, were included. Multivariable linear regression models were used to identify potential predictors associated with an impaired HRQoL, as measured by the CAF-QoL. An additional analysis was performed to examine the association between fistula disease severity and HRQoL. In this model, Domain A of the CAF-QoL, representing self-reported severity of fistula-related symptoms, was used to assess the impact of overall fistula severity on HRQoL as measured by the EQ-5D-5L. Results In total, 440 patients with active pCD were included in the cohort of which 293 (66.6%) patients were included in this study (56% female, median age 39 years interquartile range [IQR 30–51], median pCD duration 3.2 years IQR 1.1–7.5). The mean total CAF-QoL scale score was 47 (SD 22.2) and mean EQ-5D-5L utility score was 0.73 (SD 0.23). Overweight or obesity (p = 0.01 and p = 0.04), active proctitis (p = 0.04), a prior surgical intervention (between diagnosis and inclusion) aiming for fistula closure (p = 0.002), and unemployment (p = 0.01) or work absence (at least one day of sick leave within the lookback period of 4 weeks) (p 0.001) were significantly associated with reduced HRQoL as measured by the CAF-QoL. Active luminal disease was reversely associated with HRQoL as measured by CAF-QoL (p = 0.03) (Table 1). In the additional analysis unemployment (p 0.001) or work absence (p = 0.003) and fistula severity (p 0.001) were independently associated with a worse EQ-5D-5L utility score (Table 2). Conclusion Increased body weight and employment status are independently associated with reduced generic and pCD-related-HRQoL in patients with active fistula(s). In the additional analysis, fistula severity was also associated with reduced HRQoL, underscoring the substantial burden of disease on daily functioning. Incorporating weight management and work-related support into clinical practice may enhance HRQoL and promote a more holistic, patient-centered approach to IBD care. Conflict of interest: Ms. Verweij, Merel: No conflict of interest Bak, Michiel: Grant: Unrestricted research grant from Falk Pharma Benelux Other: Speaker fees from AbbVie Heemskerk, Stella: No conflict of interest Molendijk, Ilse: Advisory board and / or financial compensation from the following companies: Abbvie, Dr. Falk and Johnson & Johnson De Vries, Annemarie C.: Grant: Grants, advisory boards: Pfizer, Galapagos, Takeda, Janssen Van Ruler, Oddeke: No conflict of interest