Revés Joana, Fernandez-Clotet Agnes, Ordás Ingrid, Buisson Anthony, Bazoge Maëva, Hordonneau Constance, Ellul Pierre, D'Anastasi Melvin, Elorza Ainara, Aduna Marta, Rodríguez-Lago Iago, Lajas Inês Sousa, Raimundo Ana, Bettencourt Paulo J G, Freire Gonçalo, Sousa Pedro, Primitivo Ana, Delgado Ivo, Rimola Jordi, Torres Joana
Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal.
Department of Gastroenterology, Hospital Clínic de Barcelona- Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS- and CIBEREHD, IBD Unit, Barcelona, Spain.
Clin Gastroenterol Hepatol. 2025 Jun;23(7):1194-1203.e2. doi: 10.1016/j.cgh.2024.07.034. Epub 2024 Aug 30.
BACKGROUND & AIMS: Transmural healing (TH) is emerging as a potential Crohn's disease (CD) treatment target. Early biological treatment seems to be associated with improved disease outcomes, but its impact on TH remains unclear. We aimed to assess the impact of early biological treatment initiation on TH and its influence on CD prognosis.
This multicenter retrospective study included adult patients with CD starting biological therapy. TH was assessed using magnetic resonance enterography (MRE) at 12 ± 6 months post-therapy initiation, with radiological examinations reviewed by blinded expert radiologists. TH was defined as complete normalization of all MRE parameters. Timing of biological therapy initiation was analyzed as a continuous variable, with optimal cutoff determined using the Youden index and clinical relevance. Logistic regression with propensity score-adjusted analysis was used to assess the association between early biological therapy initiation and TH. Long-term outcomes (bowel damage progression, CD-related surgery, CD-flare hospitalization, and therapy escalation) were evaluated.
Among 154 patients with CD, early biological therapy initiation within 12 months of diagnosis was associated with significantly higher TH rates (adjusted odds ratio [aOR], 3.23; 95% confidence interval [CI], 1.36-7.70; P < .01), which persisted after adjusting for previous biological therapy use (aOR, 2.82; 95% CI, 1.13-7.06; P = .03). Time-to-event analysis demonstrated that TH was significantly associated with reduced risk of bowel damage progression (adjusted hazard ratio [aHR], 0.28; 95% CI, 0.10-0.79; P = .02), CD-related surgery (aHR, 0.21; 95% CI, 0.05-0.88; P = .03) and therapy escalation (aHR, 0.35; 95% CI, 0.14-0.88; P = .02), independently of early biological therapy.
Early initiation of biological therapy within 12 months of diagnosis significantly increases TH rates, leading to improved long-term outcomes in patients with CD.
透壁愈合（TH）正成为克罗恩病（CD）潜在的治疗靶点。早期生物治疗似乎与改善疾病预后相关，但其对TH的影响仍不明确。我们旨在评估早期开始生物治疗对TH的影响及其对CD预后的作用。
这项多中心回顾性研究纳入了开始生物治疗的成年CD患者。在治疗开始后12±6个月使用磁共振肠造影（MRE）评估TH，由不知情的专家放射科医生对影像学检查进行评估。TH定义为所有MRE参数完全正常化。将开始生物治疗的时间作为连续变量进行分析，使用约登指数和临床相关性确定最佳截断值。采用倾向评分调整分析的逻辑回归评估早期生物治疗开始与TH之间的关联。评估长期结局（肠道损伤进展、CD相关手术、CD发作住院和治疗升级）。
在154例CD患者中，诊断后12个月内早期开始生物治疗与显著更高的TH率相关（调整优势比[aOR]，3.23；95%置信区间[CI]，1.36 - 7.70；P <.01），在调整先前使用生物治疗后该关联仍然存在（aOR，2.82；95%CI，1.13 - 7.06；P =.03）。生存分析表明，TH与肠道损伤进展风险降低显著相关（调整风险比[aHR]，0.28；95%CI，0.10 - 0.79；P =.02）、CD相关手术（aHR，0.21；95%CI，0.05 - 0.88；P =.03）和治疗升级（aHR，0.35；95%CI，0.14 - 0.88；P =.02），与早期生物治疗无关。
诊断后12个月内早期开始生物治疗显著提高TH率，从而改善CD患者的长期结局。
