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P0808 Early Top-down treatment improves transmural remission rates in Crohn's disease - a risk-adjusted propensity score matched analysis

2025; Oxford University Press; Volume: 19; Issue: Supplement_1 Linguagem: Inglês

10.1093/ecco-jcc/jjae190.0982

1876-4479

Samuel Fernandes, Inês Rodrigues, Alice Neves, S Saraiva, Ana Rita Gonçalves, A Valente, P Moura Santos, Luís Correia, Helena Cortez‐Pinto, Fernando Magro,

Microscopic Colitis

Abstract Background top-down treatment with biologics has been associated with higher rates of endoscopic remission compared to step-up treatment in Crohn’s disease (CD). We evaluated the benefits of this strategy in respect to transmural remission. Methods case-cohort study including CD patients naïve to immunosuppressants and with endoscopic and radiologic evidence of active disease. Rates of transmural remission were compared between patients receiving early top-down treatment (immediate start of biologics or within 6 months of immunomodulators) and conventional step-up treatment (start of biologics > 6 months after immunomodulators). A propensity score matched analysis was performed adjusting for variables associated with disabling disease (age at diagnosis, disease duration, smoking, phenotype, perianal disease, extensive small bowel disease). Transmural remission was defined as combined endoscopic and radiologic remission. Endoscopic remission was defined as a SES-CD ≤ 3 (non-operated patients) or a Rutgeerts score <i2 (operated patients). Radiologic remission was defined as a simplified Maria score ≤1. Results 327 patients were included in the analysis, 52.3% receiving conventional step-up treatment and 47.7% early top-down treatment. Rates of transmural remission decreased from 40% to 14.3% in patients with 0 and 5 risk factors for disabling disease, respectively. Early top-down treatment resulted in higher rates of transmural remission (33.3% vs 18.1%, P= 0.002) with similar results in the propensity score matched analysis (34.9% vs 18.5, P= 0.002). In multivariate analysis, early top-down treatment increased the chances of obtaining transmural remission (OR 2.187 95%CI 1.270-3.665, P= 0.005). Conclusion Early top-down treatment with biologics improves the rates of transmural remission in CD. Risk factors for disabling disease influence the chances of obtaining transmural remission.