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 CD patients 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 cut-off 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 CD patients, early biological therapy initiation within 12 months of diagnosis was associated with significantly higher TH rates (aOR 3.23, 95% CI 1.36-7.70, p<0.01), which persisted after adjusting for previous biological therapy use (aOR 2.82, 95% CI 1.13-7.06, p=0.03). Time-to-event analysis demonstrated that TH was significantly associated with reduced time until bowel damage progression (aHR 0.28, 95% CI 0.10-0.79, p=0.02), CD-related surgery (aHR 0.21, 95% CI 0.05-0.88, p=0.03) and therapy escalation (aHR 0.35, 95%CI 0.14-0.88, p=0.02), 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 CD patients.