Early biological therapy for Crohn’s boosts transmural healing threefold, improves outcomes
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Key takeaways:
- Initiation of biological therapy within 12 months was associated with a higher rate of transmural healing (adjusted OR = 3.23).
- This finding persisted after adjusting for prior biological use (aOR = 2.82).
Initiation of biological therapy within the first year of Crohn’s disease diagnosis was associated with a higher rate of transmural healing, as well as decreased risk for bowel damage progression, surgery and therapy escalation.
“While endoscopic healing has been considered the best treatment target, CD is a transmural disease and transmural healing or radiological healing, assessed by cross-sectional imaging, has recently been shown to associate with improved outcomes as compared to endoscopic healing alone,” Joana Revés, of the department of gastroenterology at the Hospital Beatriz Ângelo in Portugal, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Aligned with the tight monitoring and treat-to-target strategies, the concept of early intervention has emerged in CD.”
They continued: “However, to our knowledge, there is no information about the impact of the timing of biological therapy initiation on the chances of achieving transmural healing, and how it translates into improved outcomes for CD patients.”
To address this need, Revés and colleagues conducted a multicenter, retrospective study of 154 patients (median age at diagnosis, 26 years; 51% women) diagnosed with CD from 1975 to 2022 who were started on biological therapy. The researchers defined timing of treatment initiation as a continuous variable from diagnosis date and reported 38% and 47% of patients initiated biologics within 12 and 24 months of diagnosis, respectively.
The primary outcome was transmural healing — defined as complete normalization of all magnetic resonance enterography parameters, including lack of intestinal and pre-enteric inflammation and CD-related complications — at 12 months, plus or minus 6 months.
According to results, 21% of patients achieved transmural healing at this timepoint.
In addition, initiation of therapy within 12 months was associated with a significantly higher rate of transmural healing (adjusted OR = 3.23; 95% CI, 1.36-7.7), a finding that persisted after adjusting for prior biologics use (aOR = 2.82; 95% CI, 1.13-7.06).
Independent of early biological therapy, time-to-event analysis also showed transmural healing was associated with reduced time to bowel damage progression (aHR = 0.28; 95% CI, 0.1-0.79), CD-related surgery (aHR = 0.21; 95% CI, 0.05-0.88) and therapy escalation (aHR = 0.35; 95% CI, 0.14-0.88).
“Our findings underscore the significance of initiating biological treatment within the first year of diagnosis for achieving higher [transmural healing] rates,” Revés and colleagues wrote. “This early intervention is associated with lower risk of bowel damage progression, CD-intestinal surgery and therapy escalation.”
They concluded: “These results emphasize the importance of timely therapeutic interventions in improving patient outcomes and minimizing disease progression in CD.”
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