Long-term Remission Research Articles

ROUX-EN-Y Gastric Bypass (BGYR) versus Sleeve Gastrectomy (GMV) in long-term remission of type 2 Diabetes: a meta-analysis of randomized studies

Introduction: As a treatment measure for obesity, bariatric surgery using Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VMS) has shown promising results in glycemic control and reduction of comorbidities. However, there are few long-term follow-up studies comparing the two techniques in obese and diabetic patients. Objective: To compare long-term diabetes remission using RYGB or VGM in patients who have undergone bariatric surgery in the last ten years. Method: Systematic review and meta-analysis carried out according to the Preferred Reporting Items for Meta-analysis protocol. An advanced search strategy was applied to Pubmed, Embase and Web of Science to select randomized clinical trials comparing RYGB and VGM in diabetes remission. The mean difference (MD) and odds ratio (OR) were calculated for binary outcomes by statistical analysis using Review Manager 5.4 software with the use of subgroups. Results: 5 randomized studies and 337 patients were included, showing that long-term remission of type 2 diabetes mellitus was higher for patients undergoing RYGB (OR 1.84; 95% CI 1.13-3.00; P-value = 0.01; I2= 0%), especially at the 5-year follow-up interval (OR 2.41; 95% CI 1.32-4.39; P-value = 0.004; I2= 0%). Conclusion: Roux-en-Y gastric bypass (RYGB) resulted in a higher remission rate of type 2 diabetes mellitus compared to vertical sleeve gastrectomy (VMS) in the long term.

Predictors of favorable long-term outcomes in first-line surgery for microprolactinomas.

Opting for first-line surgery in carefully selected patients with microprolactinomas provides the advantage of avoiding long-term dopamine agonist (DA) medication and potential associated side effects. However, the lack of comprehensive long-term data poses a challenge in identifying those patients who would benefit the most from upfront surgery. To improve guidance in the selection process for microprolactinoma patients in clinical practice, we aimed to establish simple clinical and biochemical parameters predicting non-dependence on DAs. Retrospective analysis of a prospectively maintained database, focusing on patients with microprolactinomas who underwent upfront surgery. We assessed clinical and biochemical risk factors for the patients' reliance on DAs at their latest follow-up using regression analysis. We next proceeded to conduct Receiver Operating Characteristic (ROC) analysis to determine the optimal threshold cutoff prolactin (PRL) level for practical application in clinical settings that best differentiates between surgical long-term remission status and long-term dependence on DAs. A microadenoma was observed in 46 patients, of whom 12 (26%) exhibited long-term dependence on DAs at a median follow-up of 78 months. Baseline PRL values were significantly higher in patients with long-term DA dependence compared to those without (p = 0.05). High baseline PRL values (HR 23.9, 95% CI 1.0-593.7, p = 0.05), but not the presence of headache or male gender, were identified as independent predictors of long-term dependence on DAs. PRL thresholds for discriminating long-term DA dependence were estimated to be 290µg/L (AUROC = 0.73, 95% CI 0.55-0.92, p = 0.03; sensitivity = 90%, specificity = 80%). In patients with microprolactinomas, first-line surgery presents a favorable prospect for reducing reliance on DAs. However, for those with high PRL levels ≥ 290µg/L at diagnosis, first-line surgery is not recommended, as the majority of them require adjuvant DA therapy in the long term.

Functional Impairment in Daily Living during Long-Term Remission From Substance Use Disorders

Functional Impairment in Daily Living during Long-Term Remission From Substance Use Disorders

604 Personalized chemotherapy and molecular insights in pediatric follicular lymphoma: a case series of four patients with long-term remission

604 Personalized chemotherapy and molecular insights in pediatric follicular lymphoma: a case series of four patients with long-term remission

"Psychiatric oblivion": considerations on the hypothesis of a law.

The introduction of a law on psychiatric oblivion, similar to the recent one for oncological oblivion, presents numerous complexities due to the differences between the two areas of illness, especially in terms of recovery and clinical stability. While a definitive cure is often achievable in oncological diseases, in severe mental disorders, such as schizophrenia or bipolar disorder, complete remission in the absence of therapies is rare. Even in cases of effective treatment response, patients may exhibit subclinical symptoms or cognitive and functional deficits, making the concept of psychiatric oblivion particularly problematic. Some diagnostic categories, such as brief psychotic disorder or postpartum depression, could theoretically benefit from oblivion legislation, given the potentially limited course and frequent absence of relapses. However, for the majority of psychiatric conditions the requirement of a long period of remission without therapy appears difficult to achieve. An alternative could be the introduction of criteria based on the stabilization of maintenance therapy, but this would require a more complex and less easily standardized clinical judgment. Other limitations are the residual vulnerability to relapses, the difficulty in determining a precise medical history and the influence of persistent social stigmatization, which could undermine the effects of oblivion. Therefore, the creation of a law on psychiatric oblivion would require a restrictive and selective approach, focused on specific diagnoses and long-term clinical remission criteria, tailored to the clinical and adaptive peculiarities of mental illness.

Is Extraordinary Response and Long-Term Remission of Metastatic Castration-Resistant Prostate Cancer (mCRPC) After [¹⁷⁷Lu]Lu-PSMA Radioligand Therapy Due to an Immunomodulatory Effect (Radiovaccination)? A Dual Center Experience on Super-Responders

Background: Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (PRLT) with Lutetium-177 ([177Lu]Lu-PSMA) is a safe and effective treatment for metastatic castration-resistant prostate cancer (mCRPC). The aim of our study was to evaluate clinical variables of patients with extreme response to PRLT and to assess its immunomodulatory potential. Methods: This retrospective study included 36 patients from two centers achieving extreme response after [¹⁷⁷Lu]Lu-PSMA PRLT. The primary outcomes were the duration of maintained response in months (MR) and improvement post-therapy—clinically, serologically, and on molecular (PET/CT) imaging. We examined several variables, including pathology, gene sequencing, baseline PSA, Gleason score, prior therapies, number of PRLT cycles, and pattern of disease, to identify potential factors that may influence the extreme response. Results: Between 2018 and mid-September 2024, 36 men with mCRPC received a mean of three cycles of [177Lu]Lu-PSMA PRLT. Patients were subgrouped according to clinical variables versus MR. A total of 17 patients had ≥12 months MR (17/36, 47%). The longest duration of MR was 99 months and a mean of 17.44 months (95% CI 10.05–24.84). Previous lines of treatment were evaluated for MR, p = 0.172. Pattern of disease (bone, lymph node, liver, and peritoneal) was evaluated for MR, p = 0.721. The Gleason score was evaluated for MR, p = 0.871. Patients with known BRCA sequencing status (n = 12) were analyzed with mean MR: BRCA1/2 wild-type, 6/12 (50%), 6.67 months; BRCA 1/2 negative, 1/12 (8.33%), 7 months; BRCA germline negative and somatic positive, 1/12 (8.33%), 36 months; BRCA germline negative, somatic negative, 2/12 (16.67%), 27 months; and BRCA 2 positive, 2/12 (16.67%), 43 months. Conclusions: We propose there may be intrinsic mechanisms suggesting the immunomodulatory enhancement of ionizing radiation, primarily driving extreme responses.

Very long-term remission with azacitidine in VEXAS syndrome.

Not available.

GRANULOMATOUS ROSACEA. THE EXPERIENCE IN THE TREATMENT OF THE PATIENTS.

Granulomatous rosacea is a rare variant of rosacea, which is characterized by a special clinical picture and approaches to patient management that differ from traditional rosacea. The clinical picture of granulomatous rosacea is represented by the monomorphic papules, which tends to be yellow on dermotoscopy. Treatment of this variant of rosacea is difficult, the first-line therapy of rosacea is ineffective. The article presents two cases of granulomatous rosacea similar in clinical picture, gender and age of patients, but with different approaches of treatment. Both patients were prescribed therapy with 0.1% tacrolimus ointment 2 times a day for a month, 10 procedures of photodynamic therapy. One of the patients was planning a pregnancy, in which case treatment with isotretinoin was excluded, and the other patient agreed to systemic therapy with isotretinoin. Systemic isotretinoin has been shown to be effective in a patient with granulomatous rosacea and it has been achieved long-term remission at a dose of less than 0.2 mg/kg body weight for 6 months.

Diagnostic value of 11C-Methionine PET-CT imaging in persistent or recurrent Cushing's disease after surgery.

Equivocal or negative pituitary magnetic resonance imaging (MRI) findings raise a significant challenge in the management of persistent or recurrent Cushing's disease (CD), compromising the chances of success of a further transsphenoidal surgery (TSS). The aim of our study was to determine the diagnostic utility of 11C-methionine (MET) positron emission tomography coupled with computerized tomography (PET/CT) in localizing the residual or relapsing corticotroph adenoma. We retrospectively analyzed the results of 11C-MET PET/CT performed in two tertiary medical centers between May 2002 and November 2023 in 22 patients with a persisting or recurrent CD after initial TSS and equivocal or negative pituitary MRI findings. In 15 cases, images obtained from MET PET/CT were also co-registered with high-resolution 3D T1 or FLAIR MRI pituitary imaging. All patients had a proven CD at the time of first surgery. Twenty-two patients were included (18 females and 4 males), with a mean age of 36 years at diagnosis. Initial tumors were mostly microadenomas with a mean maximum tumor diameter of 6.5 mm. Thirteen out of the 22 patients had a suspect anomaly on conventional MRI that could however not be clearly distinguished from postsurgical changes, while the remaining 9 had a negative MRI. A maximal metabolic activity in the suspected area of the tumor residue (SUVmaxT) was found in 14 patients (63.5%; 5/9 patients with negative pituitary MRI and 9/13 with equivocal findings). On the basis of positive imaging, repeat TSS was performed in 12 patients and was successful in 7, while Gamma Knife radiosurgery (GKRS) was performed in 2 patients allowing remission in both (total remission rate of 64%). Among the 5 patients not cured by TSS, the presence of a corticotroph adenoma in the resected tissue was found in 3 cases. Therefore, when positive, 11C-MET PET/CT had a detection rate accuracy of 86% (12/14). Out of the 8 PET-negative patients, exploratory TSS was performed in 2, with no remission, and GKRS was performed in another two patients, with long-term remission in one. 11C-Methionine PET/CT imaging can provide valuable diagnostic information to detect a corticotroph microadenoma in more than half of patients with persistent or recurrent CD and equivocal or negative MRI findings, thereby allowing targeted TSS or radiosurgery with a global success rate of 64% in the selected subgroup with positive imaging.

Outcome Predictors of Generalized Myasthenia Gravis: A Prospective Observational Study.

There is paucity of studies on long-term remission of autoimmune generalized myasthenia gravis (MG) from Southeast Asia. We report the outcome predictors of generalized MG and also evaluate the influence of high- versus low-dose prednisolone and prednisolone with or without azathioprine (AZA). Fifty-seven patients with generalized MG were included, who completed 2 years of follow-up. Demographic information, comorbidities, Myasthenia Gravis Foundation of America (MGFA) class at baseline and follow-up, acetylcholine receptor (AChR) and muscle-specific kinase antibodies, decremental response, thymectomy, and treatments were recorded. Maximum doses of prednisolone, AZA, and acetylcholinesterase inhibitors were noted. The predictors of MGFA 0 at 3 and 6 months and minimal manifestation (MM) status at 2 years were evaluated. MGFA 0 was achieved by 27 (47.4%) patients at 3 months, 35 (61.4%) patients at 6 months, and 46 (80.7%) patients at 12 months. At 2 years, 48 (84.2%) patients achieved the MM status and none achieved complete stable or pharmacologic remission. On multivariate analysis, AChR antibody titer (adjusted odds ratio [AOR] 1.08, 95% confidence interval [CI] 1.006-1.167; P = 0.03) and MG activity of daily living (MGADL) at 6 months (AOR 1.28, 95% CI 1.066-1.558; P = 0.01) predicted the MM status. Maximum dose of prednisolone and adjunctive AZA did not predict the MM status. About 84.2% of patients with generalized MG, especially those with a low AChR antibody titer and MGADL < 4 at 6 months, achieved the MM status at 2 years.

Personalized Immunity: Neoantigen-Based Vaccines Revolutionizing Hepatocellular Carcinoma Treatment

Hepatocellular carcinoma (HCC), the most prevalent form of primary liver cancer, presents significant therapeutic challenges due to its molecular complexity, late-stage diagnosis, and inherent resistance to conventional treatments. The intermediate to low mutational burden in HCC and its ability to evade the immune system through multiple mechanisms complicate the development of effective therapies. Recent advancements in immunotherapy, particularly neoantigen-based vaccines, offer a promising, personalized approach to HCC treatment. Neoantigens are tumor-specific peptides derived from somatic mutations in tumor cells. Unlike normal cellular antigens, neoantigens are foreign to the immune system, making them highly specific targets for immunotherapy. Neoantigens arise from genetic alterations such as point mutations, insertions, deletions, and gene fusions, which are expressed as neoepitopes that are not present in healthy tissues, thus evading the immune tolerance mechanisms that typically protect normal cells. Preclinical and early-phase clinical studies of neoantigen-based vaccines have shown promising results, demonstrating the ability of these vaccines to elicit robust T cell responses against HCC. The aim of the current review is to provide an in-depth exploration of the therapeutic potential of neoantigen-based vaccines in HCC, focusing on neoantigen identification, vaccine platforms, and their integration with immune checkpoint inhibitors to enhance immunogenicity. It also evaluates preclinical and clinical data on efficacy and safety while addressing challenges in clinical translation. By taking advantage of the unique antigenic profile of each patient’s tumor, neoantigen-based vaccines represent a promising approach in the treatment of HCC, offering the potential for improved patient outcomes, long-term remission, and a shift towards personalized, precision medicine in liver cancer therapy.

P0321 Early improvement of mental health is associated with long-term disease remission in Ulcerative Colitis

Abstract Background Emerging evidence underscore the critical role of mental health in managing ulcerative colitis. However, the potential impact of early mental health improvement on long-term therapeutic outcomes remains poorly understood. This study aimed to explore the association between early mental health improvements and long-term disease remission. Methods This was a post hoc analysis using data from the SELECTION trial (NCT02914522) involving 381 patients treated with filgotinib. Mental health was assessed using the mental health subscale of the 36-item Short-Form Survey. Endoscopic, clinical, and histologic outcomes were assessed at week 58. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Receiver operating characteristic curves, combined with bootstrap resampling, were employed to determine the mental health response threshold. Results Early mental health improvements at week 10 were significantly associated with disease remission at week 58. After adjusting for potential confounders, the aOR of mental health improvements was 1.03 (95% CI: 1.00–1.06) for endoscopic remission, 1.03 (95% CI: 1.01–1.05) for clinical remission, 1.03 (95% CI: 1.01–1.05) for histologic remission, and 1.04 (95% CI: 1.01–1.07) for disease clearance at week 58. Patients who exhibited a mental health response at week 10 (defined as an increase in the mental health subscale score of ≥7.85) were more likely to achieve long-term endoscopic remission (aOR 2.67, 95% CI: 1.43–5.25), clinical remission (aOR 1.91, 95% CI: 1.22–2.99), histologic remission (aOR 1.98, 95% CI: 1.27–3.12), and disease clearance (aOR 3.48, 95% CI: 1.74–7.50). Additionally, incorporating mental health response assessment along with clinical remission significantly enhanced outcome predictions. Specifically, patients with only clinical remission at week 10 were approximately half as likely to achieve week-58 endoscopic remission (aOR 0.45, 95% CI: 0.21–0.91) compared to those who attained both mental health response and clinical remission. Conclusion Early mental health improvements independently predicted long-term disease remission in ulcerative colitis. Integrating mental health assessments into the management strategies may provide valuable insights beyond physical symptoms.

P0943 Estimated benefits and willingness of remote monitoring in IBD patients under maintenance therapy – ATTENDANT study

Abstract Background Following STRIDE II guidelines, patients with inflammatory bowel diseases (IBD) are tightly monitored evaluating effectiveness of IBD-therapies and predicting flares. In many centres, patients on stable conventional therapy typically have annual outpatient visits with their IBD physician, while patients on advanced therapies are seen every six months. However, the growing number of IBD patients in active follow-up is straining outpatient clinic capacity and increasing time pressures on healthcare professionals. Furthermore, many patients do not require specialised interventions during these visits, and those in long-term remission often prefer less frequent follow-up to reduce absenteeism from work or school. We aimed to evaluate the potential optimization of resources of remote monitoring for IBD patients in a large-volume referral centre. Methods An anonymous survey was conducted in 300 adult IBD patients, either untreated or on stable subcutaneous or oral maintenance therapy for at least two years, to assess their interest in a remote monitoring program and gather insights into their preferences for its implementation. Results Of the 300 patients, 48% were male, 68% had Crohn’s disease, 31% ulcerative colitis and 1% IBD type unclassified. Forty-one percent had a disease duration of more than 20 years. Additionally, 17% were without any IBD-related therapy, 9% were on conventional therapy only, and 74% were receiving subcutaneous or oral advanced therapy. Most patients (68%) were actively employed, 70% of whom worked full-time. Notably, 77% (n=230) expressed interest in significantly reducing their outpatient visits in favour of remote monitoring. The study also identified cost and time savings for patients, as an outpatient visit takes approximately 3 hours (range 2-4 hours). Also, 24% incur public transport cost of 25 to 56 euros to attend the clinic (N = 41). Among the patients interested in remote monitoring, 94% were willing to complete three-monthly questionnaires taking about 10 minutes, and 94% agreed to annual blood analyses. Regarding faecal calprotectin, 66% were open to conducting home-based stool analyses every three months, while 72% would agree to bring a stool sample to their general practitioner or local hospital. Also, 79% were willing to attend biennial outpatient visits (Fig1). Patients also emphasized the importance of personal contact in establishing a trustworthy and safe remote monitoring system. Conclusion Remote monitoring is a promising program for IBD patients in stable remission, offering potential financial and time savings for employers, patients, and society. However, further research is required to evaluate the safety and feasibility of this approach.

P0540 Assessment of Metabolic-Associated Liver Disease in Patients with Crohn’s Disease in Long-Term Remission

Abstract Background Previous studies have shown that patients with Crohn’s disease(CD) have an increased risk of metabolic liver disease(MASLD) even in the absence of cardiovascular risk factors. This increased prevalence is attributed to the inflammatory bowel activity itself. However, there is less evidence on whether CD could be an independent risk factor for MASLD in patients in long-term remission Methods A cross-sectional study was conducted, including two cohorts: one of patients with CD in deep remission and another of healthy controls. All participants underwent blood tests, abdominal ultrasound with shear wave elastography(SWE) and FibroScan®. Additionally, CD patients were evaluated to determine clinical, biochemical, and radiological remission(using intestinal ultrasound). Only patients with CD in clinical remission for at least one year, and not receiving immunosuppressive or biological treatments, were included. Patients with clear predisposing risk factors to metabolic liver disease(such as corticosteroid treatment or diabetes) were excluded Results 47 patients were included: 29 controls(61.7%) and 18 with CD in remission(38.3%). The baseline characteristics are summarized in Table1. Regarding the CD remission: Harvey index median was 0(IQR 0-1). Faecal calprotectin mean was 38.8 µg/g(IQR 20.7-57.4), C-reactive protein mean was 0.6mg/dL(IQR 0.5-2.1), and intestinal ultrasound showed normal bowel wall thickness in all patients. The lipid and liver profile is presented in Table2. Considering all included patients, regardless of the presence of steatosis, Fibroscan values were significantly higher in the control group compared to CD patients, although there were no advanced fibrosis in either group(4.9kPa vs 4.1kPa,p=0.04). This was consistent with SWE data(4.3 kPa vs 4.15 kPa), although this difference did not reach statistical significance(p=0.58). ATI values were 0.54 in controls vs 0.58 in CD patients(p=0.38). Considering only patients with steatosis, there was no greater prevalence of steatosis among patients with CD(23.5%) compared to controls(20.8%),p=0.84. By ultrasound, all cases were classified as mild steatosis, except for one patient who was reported as severe, belonging to the CD group. In our sample, among patients with steatosis, those with CD were more frequently diagnosed with dyslipidaemia(75%) compared to controls(0%),p=0.018. Fibroscan values were lower in patients with CD and steatosis(3.9kPa) compared to controls(5.3kPa),p=0.26. Similar to SWE (4.02kPa vs 4.56kPa, p=0.43) and ATI(0.73 vs 0.69,p=0.74) values Conclusion In our experience, there is no increased prevalence of MASLD in CD in the absence of activity, and when present, it may be secondary to underlying cardiovascular risk factors, as in our case was dyslipidaemia

P0946 Switching from intravenous to subcutaneous Infliximab in patients with immune mediated diseases in clinical remission

Abstract Background We aimed to report on the efficacy and safety of elective switching from intravenously (IV) to subcutaneously (SC) administered Infliximab (IFX) in patients with immune mediated diseases. Methods This was a multicenter retrospective study in which we analyzed data collected from consecutive patients with immune mediated diseases treated in a hospital setting. Each hospital department was considered a study center and overall, 8 gastroenterology departments, 6 rheumatology departments and 1 dermatology department from 13 Greek hospitals, that are all referral centers, recruited patients for the study. Patients with Crohn’s disease (CD), Ulcerative Colitis (UC), Spondyloarthritis (SpA), Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and chronic plaque Psoriasis (PsO) who were receiving IFX-IV for maintenance of remission and were switched to IFX-SC based on their physician’s choice were included. All patients with gastrointestinal and skin diseases were in clinical remission, while those with musculoskeletal disease had inactive disease or low disease activity. The primary endpoint was disease deterioration during the follow up period, according to disease specific composite measures. Results Between April 2023 and April 2024, a total of 344 patients (CD=136, UC=62, SpA=52, PsA=38, RA=7, PsO=44, co-existence of more than one disease=5) were switched from IFX-IV to IFX-SC. The mean duration of treatment with IFX before switching was a mean (SD) 53.7 (36.2) months. Eleven patients (3.2%) were receiving combination treatment with an immunomodulator and 2 patients (0.6%) were using oral or iv steroids at the time of switch. After a mean (SD) follow up period of 8 (4) months, 12 patients (3.5%) discontinued treatment with IFX-SC. Five of them (1.5%) because of disease worsening and the remaining 7 (2.0%) because of the occurrence of side effects. All other 332 patients (96.5%) showed favorable response, none of them requested an unscheduled visit, or developed an adverse event (clinical or laboratory) or needed escalation of treatment. Conclusion Elective switching from IFX-IV to IFX-SC seems to be an effective and safe approach in real-world every day clinical practice to maintain long-term clinical remission, inactive disease or low disease activity in patients with immune-mediated diseases.

P0041 Assessment of real-world effectiveness of risankizumab in patients with moderate-severe Crohn’s disease in a global setting

Abstract Background The primary treatment goals in Crohn’s disease (CD) are to control symptoms, such as abdominal pain and diarrhea, and induce long-term endoscopic remission. The biologic risankizumab (RZB) was approved in 2022 for the treatment of adult patients with moderate-severe CD. As data on RZB utilization and effectiveness are limited, this study aimed to assess the impact of RZB on disease remission and symptom control for optimizing treatment outcomes in patients with CD. Methods Data were drawn from the Adelphi Real World CD Disease Specific Programme, a cross-sectional survey with retrospective data collection of gastroenterologists (GIs) in France, Germany, Italy, Spain, the UK, and the USA from Feb 2023–Oct 2024. GIs provided data on their consulting patients with subjectively classified at RZB initiation moderate-severe CD reported demographics, clinical characteristics and symptoms at RZB initiation and at most recent consultation. Analyses were descriptive, Wilcoxon signed rank and McNemar tests were used to compare severity and symptoms at RZB initiation and at most recent consultation, respectively. Results Overall, 206 GIs reported data on 333 patients with moderate-severe CD receiving RZB. Mean (standard deviation; SD) patient age was 40.8 (13.0), disease duration was 4.7 (5.8) years; 54% were advanced therapy (AT, comprising biologics and small molecule therapies) naïve and 46% AT experienced (Table 1). Among all patients, 85% received RZB as a monotherapy; 6% received RZB with corticosteroids and 9% with 5-aminosalicylates and/or immunomodulators for; mean (SD) time on RZB among those with a known treatment duration (n=299) was 7.5 (7.5) months. Among patients receiving RZB for &amp;gt;6 months (n=140), 55% were in GI-reported clinical remission at most recent consultation. Among all patients, GI-reported moderate-severe disease severity significantly reduced from RZB initiation (100% of patients) to most recent consultation (55%; p&amp;lt;0.0001; Fig 1A). Key symptoms experienced at RZB initiation (abdominal pain, 87%; bloody diarrhoea, 29%; non-bloody diarrhoea, 59%; fatigue, 54%; bowel urgency, 41%) significantly reduced at most recent consultation with continued RZB treatment (48%, 9%, 35%, 38%, 20%, respectively; p&amp;lt;0.0001; Fig 1B). Conclusion In a real-world global setting, patients with moderate-severe CD treated with RZB experienced a significant reduction in GI-reported disease severity and improvement in key symptoms, and over half of patients were in GI-reported clinical remission. The improvement in symptoms and severity were greater among patients who were treated for a longer duration with RZB. These results highlight the real-world effectiveness of RZB in managing disease activity and symptom burden among patients over time.

P0505 Use of intestinal ultrasound in a tight monitoring approach in Crohn’s disease patients treated with anti-TNFα therapy: a multicentre prospective study

Abstract Background Intestinal ultrasound (IUS) is a non-invasive tool increasingly being used to assess response to therapy in Crohn’s disease (CD). Although endoscopic remission (ER) is currently the consensual long-term treatment target, transmural remission is considered a potential target in the STRIDE-II recommendations. We aimed to assess the potential predictive role of ultrasonographic parameters for ER. Additionally, we describe the correlation of IUS with laboratorial and endoscopic parameters. Methods This multicentric prospective longitudinal study enrolled adult patients with active CD starting anti-TNF. IUS and ileocolonoscopy were performed at baseline and at 54 weeks. Additionally, IUS was performed at week (W) 14 and 30. The primary outcome was the predictive value of ultrasound remission (normalization of bowel wall thickness (BWT), bowel wall stratification, vascularization and inflammatory fat) for long-term endoscopic remission at 54 weeks (segmental SES-CD=0). The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) was also calculated and its optimal cut-point to detect ER was identified using ROC analysis. Univariable/multivariable analysis including clinical, biomarkers and ultrasonographic parameters was performed to identify independent predictors of ER. Results 63 patients with CD were included, of those 57 (90%) were followed-up until week 54. After one year of therapy, 32% achieved ER and 42% IUS remission. Following therapy initiation there was a positive evolution of all IUS parameters. The reduction of BWT and IBUS-SAS was significantly more pronounced in the first 14 weeks of therapy (BWT: W0-14 vs W14-30, p=0.010; IBUS-SAS: W0-14 vs W14-30, p=0.003; W0-14 vs W30-54, p=0.005). Patients with endoscopic response and endoscopic remission had a significantly lower median IBUS-SAS score at all timepoints (Figure 1). The best predictor for endoscopic remission was IBUS-SAS score at W14 (AUC 0.805, cut-off value 52.3). On multivariable analysis, IBUS-SAS at W14 &amp;lt;52.3 was the only independent predictor for ER (OR 7.40; 95% CI 1.20-45.47; p=0.031). Additionally, BWT showed consistent moderate correlation with fecal calprotectin values across all timepoints (ρ=0.44-0.49, p=0.001). Conclusion Early assessment of ultrasonographic remission at week 14 can help predict endoscopic remission after 1 year of therapy and offers an opportunity for early therapy optimization. Using a combination of IUS parameters (IBUS-SAS) performed better than BWT alone to predict endoscopic remission. Our results support the use of IUS in a tight monitoring strategy to predict treatment response in CD. Figure 1: Median BWT and IBUS-SAS score in patients with and without endoscopic response and endoscopic remission. *p&amp;lt;0.05; **p&amp;lt;0.001

P0484 Impact of Early Aggressive Treatment on Long-term Biochemical Marker Patterns in Inflammatory Bowel Disease: A latent class mixed model

Abstract Background Inflammatory bowel disease (IBD) shows a highly variable disease course, making early identification of patients at risk for poor outcomes important for personalized treatment. This study aimed to classify the long-term disease course in patients with IBD using biochemical markers and to investigate the clinical factors associated with different disease trajectories. Methods Longitudinal data on C-reactive protein (CRP) and fecal calprotectin (FCP) levels were collected from patients in a tertiary hospital cohort between 2017 and 2023. Patients with at least two CRP and FCP tests between six months and five years after IBD diagnosis were included. Early IBD-related treatments, ER visits, and hospitalizations were defined as occurring within six months of diagnosis. A latent class mixed model (LCMM) was employed to identify the distinct subclasses based on CRP or FCP changes. Subsequently, univariate analyses and multinomial logistic regression were conducted to evaluate the relationships between different biochemical trajectories and clinical variables. Results Among the patients, 245 with CD and 635 with UC were included in the CRP model, while 256 with CD and 536 with UC were included in the FCP model. Through LCMM, a three-class model was found to be most appropriate for patients with both CD and UC: Class 1, characterized by early and sustained biochemical remission; Class 2, featuring delayed remission; and Class 3, marked by prolonged difficulty in achieving remission for over five years. In the CRP trajectory analysis, early initiation of immunomodulators (IM) in patients with CD was significantly associated with a higher probability of belonging to Class 1 (Class 2 vs. 1, odds ratio [OR] 0.344; Class 3 vs. 1, OR 0.472; p-value = 0.039). In the FCP trajectory analysis, early advanced therapy (AT) significantly increased the odds of belonging to Class 1 for patients with CD (Class 2 vs. 1, OR 0.383; Class 3 vs. 1, OR 0.220; p-value = 0.004). Conversely, no significant factors were identified in the CRP trajectory analysis for patients with UC. In UC, younger age at diagnosis (Class 2 vs. 1, OR 0.969; Class 3 vs. 1, OR 0.980; p-value = 0.004) and early IM initiation (Class 2 vs. 1, OR 2.928; Class 3 vs. 1, OR 2.698; p-value &amp;lt;0.001) were associated with higher odds of belonging to Class 2 or 3, whereas current smoking was associated with a higher likelihood of belonging to Class 1 in the FCP trajectory analysis (Class 2 vs. 1, OR 0.194; Class 3 vs. 1, OR 0.559; p-value = 0.008). Conclusion Early aggressive treatments, particularly the prompt initiation of AT in CD, may contribute to achieving long-term biochemical remission; however, similar associations were not observed in UC.

P0294 Functional outcomes after primary ileocecal resection for Crohn’s disease

Abstract Background Ileocecal resection (ICR) is a common procedure in Crohn’s disease (CD). Increasing evidence suggests ICR may be considered a first-line treatment for localized ileal CD to maintain long-term remission, rather than starting biologics. However, removal of the ileocecal valve affects bowel transit and disabling symptoms may arise. The aim of our study was to prospectively assess the impact of primary ICR on daily digestive symptoms in CD patients. Methods We included patients who underwent primary ICR at Saint-Antoine Hospital between January 2017 and December 2022. Patients were assessed after a morphological evaluation (endoscopy or MRI) performed between 5 months and 1 year post-ICR. Digestive symptoms were prospectively and systematically collected using a dedicated database. The primary endpoint was the prevalence of a composite outcome, defined as at least 4 soft or liquid stools per day and/or a fecal urgency with inability to delay defecation for more than 15 minutes, and/or moderate to severe daily abdominal pain. Secondary endpoints included other digestive symptoms. Multiple logistic regression analysis was performed to assess predictive factors for the primary outcome. Results One hundred nine patients were included. Indications for ICR were fistulizing disease (n=61, 56%) and stenosis (n=41, 37.6%). Only 7 patients (6.4%) had surgery for uncomplicated inflammatory disease. Thirty-five patients (32.1%) had morphological recurrence, defined as i2b, i3, i4 score, deep ulcers, stenosis, or fistulas on MRI. The primary endpoint was met by 24 patients (22%), with 21.1% having at least 3 liquid stools per day. Diarrhea (soft to liquid stools daily) was observed in 56.9%, fecal urgency in 22.9%, and abdominal pain in 32.1% (Figure 1). The primary endpoint prevalence was 17.6% in patients without morphological recurrence and 31.4% in those with recurrence (p=0.17) (Table 1). Multivariate analysis showed that age &amp;gt;40 years at surgery (OR=3.58 [95%CI 1.06-12.8] p=0.04), disease duration &amp;gt;2 years (OR=5.67 [95%CI 1.69-23.0] p=0.008), sepsis (fever &amp;gt;38.3°C within 7 days before surgery) (OR=8.06 [95%CI 1.68-44.2] p=0.01), and small bowel resection length &amp;gt;40 cm (OR=9.50 [95%CI 2.35-45.8] p=0.003) were associated with poorer digestive quality of life as defined by the primary composite endpoint. Conclusion The prevalence of digestive symptoms after primary ICR for CD is notable, regardless of disease recurrence. Advanced age, long disease duration, sepsis at surgery, and resection length were associated with disabling digestive symptoms. These results suggest that ICR leads to frequent and disabling digestive symptoms for many patients, which should be considered when proposing ICR.

P0628 Patient preferences towards treatment attributes in Inflammatory Bowel Disease: a Brazilian cohort study

Abstract Background Inflammatory bowel disease (IBD) is a chronic condition of the gastrointestinal tract characterised by recurring inflammation that usually requires life-long treatment. As the therapeutic landscape is rapidly expanding, there is a growing need to understand patient perceptions of treatment-related attributes. This study explored the preferences for treatment attributes in patients with Crohn’s disease (CD) or ulcerative colitis (UC) in Brazil. Methods Adult patients from Argentina, Australia, Brazil, Saudi Arabia and Taiwan who self-reported diagnosis of CD or UC participated in an online survey. In a discrete choice experiment, the relative importance of treatment attributes for CD or UC was estimated using conditional and multinomial logit models. Results In Brazil, 200 patients completed survey responses (CD, n = 100; UC, n = 100), with mean patient ages of 34.9±7.9 and 36.1±9.4 years, respectively. Most patients were covered by private insurance, and the majority had been exposed to advanced therapies (74% for CD and 62% for UC). These patients were primarily treated at IBD centers and private hospitals, with a higher percentage reporting general good or fair well-being (82% for CD and 85% for UC). Patients with CD ranked long-term remission on maintenance therapy (34.8%), the rate of 1-year remission (26.2%), and the route of administration (22.3%) as the most important attributes. Patients with UC prioritized corticosteroid-free remission after 1 year (30.3%), the route of administration (30.1%), and the rate of mucosal healing after 1 year (16.2%). Both CD and UC patients considered abdominal pain as the most impactful symptom on their daily lives. General and emotional well-being were rated as the first and second most important aspects for improvement through treatment. Conclusion Patient preferences for treatment attributes correlate with CD or UC clinical manifestations and management, highlighting the importance of personalised care and shared decision-making to maximize treatment benefits and provide valuable insights for the stakeholders involved from drug development to treatment access.