Balloon-assisted Enteroscopy Assesses Endoscopic Remission and Mucosal Healing Following Risankizumab Initiation in Crohn’s Disease

Background: Endoscopic control of inflammation is a key treatment goal in Crohn’s disease. However, real-world endoscopic outcomes of risankizumab assessed by paired balloon-assisted enteroscopy remain limited. We examined endoscopic outcomes at the visit closest to week 52 after risankizumab initiation using paired balloon-assisted enteroscopy. Methods: We retrospectively studied adults with Crohn’s disease who initiated risankizumab. The primary analysis set comprised 42 patients who underwent balloon-assisted enteroscopy at baseline and at the visit closest to week 52. Endoscopic activity was quantified using the Simple Endoscopic Score for Crohn’s Disease (SES-CD). Endoscopic remission was defined as SES-CD ≤4 with a decrease of ≥2 points from baseline, and mucosal healing was defined as SES-CD ≤2. Results: In the paired-enteroscopy cohort (n=42), the median SES-CD improved from 9 at baseline to 2 at follow-up (P < .0001). At follow-up, 76.2% (32/42) achieved endoscopic remission and 52.4% (22/42) achieved mucosal healing. Endoscopic remission was more frequent in biologic-naïve than biologic-experienced patients (93.3% vs. 66.7%, P = .05), whereas mucosal healing rates were similar (53.3% vs. 51.9%, P = .92). Conclusions: In this real-world Japanese cohort, risankizumab was associated with significant endoscopic improvement on paired balloon-assisted enteroscopy at follow-up. Endoscopic remission and mucosal healing rates were high, particularly among biologic-naïve patients.