Purpose: Current evidence suggests that treatment strategies focused on controlling symptoms do not alter the course of Crohn's disease (CD). Mucosal healing (MH) as a treatment target is of growing interest because it is associated with improved outcomes. We therefore evaluated utility of “treating to target,” according to endoscopic findings to reach MH. Methods: The medical records of 199 patients with CD followed in a single inflammatory bowel disease unit from 2011 to 2012 were reviewed through April, 2013. After an initial assessment, endoscopic outcomes were reviewed in all patients with baseline endoscopic lesion. Cumulative incidence of MH (disappearance of all baseline ulcerations) and endoscopic improvement (disappearance of deep ulceration) from the first clinic were estimated using a Kaplan-Meier method. Independent predictors and factors associated with MH were identified using a Cox proportional hazards model. Results: At baseline, the median age was 38 (IQR75 25-52) and median disease duration was 6.8 years (IQR75 1.5-18.5). Previous treatment included immunosuppressives, TNF antagonists and surgery for 58 (52.7%), 58 (52.7%) and 42 (38.1%) of patients, respectively. A total of 68 patients (out of 174 patients) underwent repeat endoscopic assessment, representing a total of 163 procedures (including baseline assessments). The median time between two procedures was 26 weeks (IQR75 18.1-38). Second and subsequent assessments were a priori planned to assess response to adjusting therapy, and 56 patients were asymptomatic at the time of assessment. After a median follow up of 62 weeks, 34 patients (50%) achieved MH and 41 (60.3%) patients had endoscopic improvement. The cumulative probabilities of endoscopic improvement were 11%, 38% and 61% at 24, 52 and 76 weeks respectively, and cumulative probabilities of mucosal healing were 16%, 47%, and 70% at 24, 52 and 76 weeks, respectively. None of the baseline factors were independently predictive of mucosal healing, including prior or current use of immunosuppressives and TNF antagonists. Importantly, independent factors associated with mucosal healing were a median time between endoscopy under 26 weeks (HR=2.13;95%IC 1.04 to 4.47, p=0.038) and any therapeutic change in case of absence of MH (including biologics introduction, optimization, switch or immunosuppressive introduction or switch) (HR=3.2; 95%IC 1.46 to 8.04, p=0.003). Conclusion: We demonstrate that repeated objective measurement of disease activity and adjusting therapy to the target of MH is feasible and highly effective. Randomized trials that evaluate treat-to-target algorithms are needed to determine if this treatment strategy can change the course of the disease. Disclosure - G. Bouguen Lecture fee(s) from: AbbVie, Ferring and MSD Pharma, B. Levesque Consultancy for: Prometheus labs, Santarus Inc., S. Pola and E. Evans: None Declared, W. J. Sandborn received research support and is a consultant to Janssen, Abbvie (formerly Abbott Laboratories), and UCB Pharma.