S1314 The Impact of Disease Status After Biologic Induction Therapy on Long-Term Outcomes in Persons With Crohn’s Disease

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Introduction: Historically, less than 20% of patients with Crohn’s disease (CD) achieve clinical remission after induction with biologic therapy. It is unknown how response to biologic induction influences disease behavior, treatment patterns, and healthcare utilization for patients maintained on biologic therapy long-term. We aimed to elucidate the impact of achieving clinical remission after biologic induction on long-term disease outcomes. Methods: We conducted a retrospective cohort study including all patients with CD who completed biologic induction at Mount Sinai Hospital, Canada before June 30, 2021. Patients were stratified by response to biologic induction as per physician global assessment as remitters (clinical remission) and non-remitters (partial or no-response). We extracted data on disease activity (symptoms, biochemistry, endoscopy, imaging), inflammatory bowel disease (IBD)-related complications, IBD-related healthcare utilization (emergency department, hospitalization, surgery), and changes to pharmacotherapy until end of follow-up. Endoscopic remission was defined as SES-CD score less than 4 or based on the endoscopist's impression. Results: Of the 160 patients included, 35.6%, 25.0%, and 28.9% had stricturing, penetrating, and perianal disease respectively, with 34.3% having a history of CD surgery. Index biologic included infliximab (24.4%), adalimumab (32.5%), vedolizumab (25.0%), and ustekinumab (11.9%). After biologic induction, 34.4% and 65.6% of patients were stratified as remitters and non-remitters respectively. Remitters were less likely to have upper gastrointestinal CD (3.6% vs 10.5%), penetrating complications (18.2% vs 28.6%), and perianal disease (16.4% vs 35.2%) at biologic start. Compared to non-remitters, remitters were more likely to be in clinical remission throughout follow-up (47.2% vs 27.6%, P =0.01) and in clinical remission at last follow-up (87.2% vs 69.5%, P =0.04). Remitters were less likely to undergo CD-related bowel resection (3.6% vs 13.3%, P =0.05) or discontinue index biologic (7.2% vs 16.1%, P =0.06). There appeared to be no significant difference in IBD hospitalizations (10.9% vs 19.0%, P =0.14) or ED visits (7.2% vs 13.3%, P =0.26). There was no difference in rates of ulcer persistence (51.6% vs 53.5%, P =0.63) or achievement of endoscopic remission (58.9% vs 48.7%, P =0.76) between remitters and non-remitters. Conclusion: Achieving clinical remission after biologic induction is associated with sustained clinical remission and reduced likelihood of subsequent CD-related bowel resection.

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