P0998 Mucosal Healing and Long-Term Medication Survival in Crohn’s Disease Patients Treated with Anti-TNF Therapy

Abstract

Listen

Translate article

Abstract Background Mucosal healing (MH) has emerged as a pivotal therapeutic goal in the management of Crohn’s disease (CD), serving as a key prognostic marker associated with sustained clinical remission, reduced hospitalization rates, and fewer surgical interventions. Anti-TNF therapy, encompassing infliximab (IFX) and adalimumab (ADA), has significantly advanced the treatment landscape by promoting endoscopic healing. This study aimed to evaluate the long-term survival of anti-TNF therapy and to compare clinical and endoscopic remission rates between IFX and ADA in CD patients. Methods CD patients treated with anti-TNF therapy were included. The Crohn’s Disease Activity Index (CDAI) was used to assess the clinical activity of the disease. Endoscopic activity was assessed using the Simplified Endoscopic Score for Crohn’s Disease (SES-CD). The variables were clinical response (drop in CDAI > 70 points) and clinical remission (CDAI < 150 points), and endoscopic response (drop in SES-CD of at least 50% in relation to the initial score), and endoscopic remission (SES-CD ≤ 2 points). Results 92 patients were included, mean age 40.49±13.67 years, 48 (52.2%) using ADA and 44 (47.8%) using IFX. Clinical/endoscopic remission rates were 77.08%/59.09% in 1 year, 74.29%/68.57% at 2 years, 81.25%/77.42% at 3 years, and 88%/72% in 5 years. Medication survival rates for clinical remission were 82.95% at 1 year, 74.67% at 3 years, 56.89% at 5 years, and 23.01% at 10 years. The average survival was 7.46 years, with no difference between ADA and IFX (Log Rank=0.36). Survival rates for endoscopic remission were 67.72% at 1 year, 59.74% at 3 years, 45.46% at 5 years, and 12.90% at 10 years. The average medication survival was 5.61 years, with higher rates in the IFX group (Log-Rank=0.0043). Clinical and endoscopic response rates were 81.25%/73.86% at 1 year, 74.29%/80% at 2 years, 84.38%/80.65% at 3 years, and 92%/80 % in 5 years. Conclusion Anti-TNF therapy demonstrated a 50% survival rate at 5 years, with IFX showing superior long-term medication survival in achieving endoscopic remission. These findings reinforce the importance of mucosal healing as a critical therapeutic endpoint in CD management and highlight the durability of anti-TNF agents in clinical practice Figure 1: Survival curves for clinical (A; Log-Rank = 0.3653) and endoscopic (B; Log-Rank = 0.0043) remission comparing adalimumab (ADA) versus infliximab (IFX).