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Multicenter Study
. 2025 Jun;23(7):1194-1203.e2.
doi: 10.1016/j.cgh.2024.07.034. Epub 2024 Aug 30.

Early Biological Therapy Within 12 Months of Diagnosis Leads to Higher Transmural Healing Rates in Crohn's Disease

Joana Revés  1 , Agnes Fernandez-Clotet  2 , Ingrid Ordás  2 , Anthony Buisson  3 , Maëva Bazoge  3 , Constance Hordonneau  4 , Pierre Ellul  5 , Melvin D'Anastasi  6 , Ainara Elorza  7 , Marta Aduna  8 , Iago Rodríguez-Lago  7 , Inês Sousa Lajas  9 , Ana Raimundo  9 , Paulo J G Bettencourt  10 , Gonçalo Freire  11 , Pedro Sousa  11 , Ana Primitivo  11 , Ivo Delgado  11 , Jordi Rimola  12 , Joana Torres  13
Affiliations
Multicenter Study

Early Biological Therapy Within 12 Months of Diagnosis Leads to Higher Transmural Healing Rates in Crohn's Disease

Joana Revés et al. Clin Gastroenterol Hepatol. 2025 Jun.

Abstract

Background & aims: 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.

Methods: This multicenter retrospective study included adult patients with CD 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 cutoff 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.

Results: Among 154 patients with CD, early biological therapy initiation within 12 months of diagnosis was associated with significantly higher TH rates (adjusted odds ratio [aOR], 3.23; 95% confidence interval [CI], 1.36-7.70; P < .01), which persisted after adjusting for previous biological therapy use (aOR, 2.82; 95% CI, 1.13-7.06; P = .03). Time-to-event analysis demonstrated that TH was significantly associated with reduced risk of bowel damage progression (adjusted hazard ratio [aHR], 0.28; 95% CI, 0.10-0.79; P = .02), CD-related surgery (aHR, 0.21; 95% CI, 0.05-0.88; P = .03) and therapy escalation (aHR, 0.35; 95% CI, 0.14-0.88; P = .02), independently of early biological therapy.

Conclusions: Early initiation of biological therapy within 12 months of diagnosis significantly increases TH rates, leading to improved long-term outcomes in patients with CD.

Keywords: Biologic; Crohn’s Disease; Early; Magnetic Resonance Enterography; Transmural Healing.

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