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P628 Long-term outcomes with transmural healing vs. mucosal healing in Crohn’s disease: time for new treatment goals ?

F. Castiglione1, N. Imperatore*1, A. Testa1, G. D. De Palma2, O. M. Nardone1, L. Pellegrini1, N. Caporaso1, A. Rispo1

1Gastroenterology, School of Medicine Federico II of Naples, Naples, Italy, 2Surgical Endoscopy, School of Medicine Federico II of Naples, Naples, Italy

Background

While mucosal healing (MH) has been proved to predict relevant clinical outcomes in Crohn’s disease (CD), little is known about the long-term significance of transmural healing (TH). The aim of this study was to prospectively assess the 1-year clinical outcomes in CD patients achieving TH following treatment with biologics, and to compare them with those in patients reaching only MH or no healing (NH).

Methods

We carried out an observational longitudinal study, evaluating 1-year outcomes in terms of steroid-free clinical remission (CR), rate of hospitalisation and need for surgery in a group of CD patients treated with anti-TNF-α for 2 years. On the basis of clinical, endoscopic, and sonographic findings, patients were divided in 3 groups: patients achieving TH, patients achieving MH only, and patients with NH.

Results

Out of 218 patients who completed a 2-year treatment course with anti-TNF-α, 68 (31.2%) presented TH (plus MH), 60 (27.5%) MH only, and 90 (41.3%) did not achieve any intestinal healing (NH). TH was associated with a higher rate of steroid-free CR (95.6%), and lower rates of hospitalisation (8.8%) and need for surgery (0%) at 1 year compared with MH (75%, 28.3% and 10%, respectively) and NH (41%, 66.6% and 35.5%, respectively) (p < 0.001). Furthermore, TH was associated with longer intervals until clinical relapse (HR 0.87, p = 0.01), hospitalisation (HR 0.88, p = 0.002) and surgery (HR 0.94, p = 0.008) than MH. Also among patients discontinuing treatment with biologics, TH predicted better clinical outcomes at 1 year than MH (p < 0.01).

Conclusion

TH is an ambitious and powerful treatment goal associated, to a greater extent than MH, with improvement of all clinical outcomes. Additionally, TH is associated with better long-term clinical outcomes than MH also after discontinuation of biologics.