P653 Tight control and Treat to target increase the rates of Transmural remission and Transmural response in Crohn’s disease
Fernandes, S.R.(1,2)*;Bernardo, S.(1,2);Rita Gonçalves, A.(1,2);Moura dos Santos, P.(1,2);Valente, A.(1,2);Tato Marinho, R.(1,2);Correia, L.(1,2);
(1)Hospital Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Serviço de Gastrenterologia e Hepatologia, Lisboa, Portugal;(2)Clinica Universitária de Gastrenterologia, Faculdade de Medicina de Lisboa, Lisboa, Portugal;
increasing evidence support the use of Transmural remission as a treatment target in Crohn’s disease (CD) but few patients can reach it with currently available therapies. Treat-To-Target (T2T) and Tight-Control (TC) strategies may potentially improve these results.
Methods: single-center retrospective study including 123 CD patients with active colonoscopy (CN) and magnetic resonance enterography (MRE) at baseline and with available follow-up CN and MRE for reassessment of remission. We evaluated the effects of T2T and TC strategies on the rates of Transmural remission and Transmural response. Patient submitted to bowel surgery between examinations were excluded.
Definitions: CN activity: ulcers in non-operated patients or Rutgeerts score> i1 in operated patients; MRE activity: bowel thickness >3 mm and enhancement on T1/T2 sequences. Transmural remission: inactive CN and MRE at reassessment; Transmural response: improvement from baseline in either examination. T2T: treatment decisions resulting in both clinical remission (Harvey-Bradshaw <5) and fecal calprotectin remission (Fc <250 ug/g) at reassessment. TC: treatment decisions resulting in persistent Fc remission (≥ 2 consecutive results, including reassessment).
48.0% and 42.3% of patients followed a T2T and TC strategy, respectively. Transmural remission and Transmural response were reached by 33.3% and 69.1% of patients, respectively. T2T resulted in higher rates of Transmural remission (55.9% vs 12.5%, P<0.001) and Transmural response (91.5% vs 48.4%, P<0.001). TC was also associated with higher rates of Transmural remission (51.9% vs 19.7%, P<0.001) and Transmural response (90.4% vs 53.5%, P<0.001). In multivariate regression, T2T (OR 9.30 95%CI 2.85-30.30, P<0.001), TC (OR 3.85 95%CI 1.18-12.54, P=0.025) and starting biologic treatment (OR 3.63 95%CI 1.36-9.70, P=0.010) were independent predictors of reaching Transmural response. T2T was the only independent predictor of reaching Transmural remission (OR 6.540 95%CI 2.41-17.74, P<0.001).
Patients following a T2T and TC strategy presented higher rates of Transmural remission and Transmural response.