DOP135Bowel damage and disability in Crohn’s disease in the first year after diagnosis - results from the CROCO study.

Abstract Background Crohn’s disease (CD) progression can result in bowel damage (BD) and disability. BD is often believed to occur as a consequence of long-term progression. However, there is limited data about the early occurrence of BD within the first year of disease. Methods The Crohn’s Disease Cohort (CROCO) is a multicentre European study enrolling newly diagnosed CD patients (12 months since diagnosis) and prospectively following them for 5 years to characterise BD progression and disability. BD is assessed using the Lémann Index (LI) (0 – no damage to 115 – maximal damage) at years 1 (Y1), 3, and 5 after diagnosis. The presence of any degree of BD was defined as a LI 0, and the presence of significant BD as a LI 2.1 Disability is evaluated every six months using the IBD-Disability Index (IBD-DI). Here, we report BD at Y1 and its associations with key disease features and with the IBD-DI. Results 539 patients were enrolled across 19 centres, with a median interval between diagnosis and inclusion of 3.7 months (IQR 1.5–7.3). Of these, 415 completed the Y1 visit, and 243 (58%) the LI evaluation 57% male; median age at diagnosis 35yo (IQR 25–50). At inclusion, 89% had ileal or ileocolonic disease, 73% had inflammatory phenotype, and 8% had perianal disease. During the first year, 10% underwent surgery (18 intestinal, 5 perianal) and 21% required hospitalisation. During the first year after diagnosis, 18% received 5-ASA, 30% systemic corticosteroids, 36% immunosuppressants, and 61% advanced therapy. The median time from diagnosis to advanced therapy was 3.5 months (IQR 1.4–5.7), with 48% initiating it within six months. Overall, 64% of patients showed some degree of BD at Y1, although the median LI remained low 0.6 (IQR 0–1); 41 patients (17%) had significant BD. In multivariate logistic regression analysis, B2/B3 behaviour (p 0.001) and perianal disease (p = 0.008) were independently associated with BD at Y1 (Table 1). In a sensitivity analysis restricted to B1 patients without prior surgery, isolated colonic disease (L2) was associated with a decreased likelihood of BD (OR 0.34, 95% CI 0.12–1.00, p = 0.039). Among patients with LI data, 227 completed the IBD-DI at Y1. The median IBD-DI was 16 (IQR 10–29), with 18% showing moderate-to-severe disability (IBD-DI35). No association was observed between any BD and moderate-to-severe disability (OR 1.06, 95% CI 0.52–2.15, p = 0.88). Conclusion In this cohort of newly diagnosed CD patients, two-thirds showed some degree of BD after one year, which was mostly minimal, with only 17% developing significant BD and 18% experiencing moderate-to-severe disability. No association was observed between BD and disability. These findings support early disease as an important period for disease modification. Reference: 1. Gilletta C, Lewin M, Bourrier A, Nion-Larmurier I, Rajca S, Beaugerie L, Sokol H, Pariente B, Seksik P, Cosnes J. Changes in the Lémann Index Values During the First Years of Crohn’s Disease. Clin Gastroenterol Hepatol. 2015 Sep;13(9):1633-40.e3. Conflict of interest: Revés, Joana: Has received consulting fees from Janssen and Pfizer. Arebi, Naila: Personal Fees: Janssen,Lilly, Pfizer and Takeda Non-financial Support: Janssen (J & J), Novonesis Fadra, Adam: None to declare Madsen, Gorm Roager: None Burisch, Johan: Grant: Johnson & Johnson, MSD, Takeda, Tillots Pharma, BMS, Novo Nordisk Personal Fees: Celgene, MSD, Pfizer, AbbVie, Takeda, Tillots Pharma, Samsung Bioepis, BMS, Pharmacosmos, Galapagos, Zealand Pharma, Orion Pharma, Ferring, Johnson & Johnson Cravo, Marilia: None Bonnet-Dodel, Marie: None Kaimakliotis, John: None Vieujean, Sophie: Speaker fees from Abbvie, Takeda and Janssen. Van Kemseke, Catherine: No conflicts Ellul, Pierre: No Conflicts Conti, Kelly: None. Duricova, Dana: Personal Fees: Lecture fee from Janssen, Takeda, Pfizer, Eli Lilly, AbbVie, Ferring. Horutova, Jana: None. Rodríguez-Lago, Iago: Financial support for traveling and educational activities from or has served as an advisory board member for Abbvie, Adacyte, Alfasigma, Biogen, Chiesi, Faes Farma, Ferring, Fresenius Kabi, Galapagos, Johnson & Johnson, Eli Lilly, Mirum Pharmaceuticals, Merck, Pfizer, Roche, Takeda, and Tillotts Pharma. Research support from AbbVie. Supported by a research grant from Gobierno Vasco-Eusko Jaurlaritza (Grant No 2020111061 and 2023222006). Elorza, Ainara: None. Ordás Jiménez, Ingrid: None. Fernandez Clotet, Agnes: None Sebastian, Shaji: Grant: Takeda, Tillots pharma, Biogen, Pfizer, Abbvie, Johnson & Johnson, Olympus -Odin Vision Personal Fees: Tillots, Johnson & Johnson, Olympus Odin Vision, AbbVie, Takeda, Merck, Pharmacosmos, Amgen, Eli Lilly, BMS, Odin Vision Non-financial Support: Tillots, Takeda, AbbVie, Celltrion, Johnson & Johnson, Eli Lilly, Alphasigma, Ferring Pharma Thut, Jessica: None. Mocanu, Irina: None. Hernández Ramirez, Vicente: Vicent Hernandez has served as consultant, has served as speaker, has received travel support or research funding from MSD, AbbVie, Ferring, Dr. Falk Pharma, Tillotts Pharma, Pfizer, Takeda, Janssen, KernPharma Biologics, Adacyte, Sandoz, FAES Farma, Galapagos, Lilly and Casen-Recordati Fumery, Mathurin: Grant: Pfizer Personal Fees: Abbvie, Janssen, Takeda, MSD, Biogen, Amgen, Sandoz, Fresenius, Gilead, Celgene, Galapagos, Mylan, Tillots, Ferring, Pfizer, Hospira, CTMA, Boehringer, Lilly, Arena Non-financial Support: Abbvie, Janssen, Takeda, MSD, Galapagos, Ferring, Pfizer Nachury, Maria: Abbvie, Alfa Sigma, Biosynex, Celltrion, Galapagos, Janssen, Lilly, MSD, Pfizer, Takeda Pedersen, Natalia: No any Rajão Saraiva, Margarida: None. Goldiș, Adrian Eugen: None. Guedes, Ana: None. Ribeiro, Ana Raquel: None. Ungaro, Ryan: Personal Fees: AbbVie, Bristol Myers Squibb, Genentech, Lilly, Pfizer, Janssen, Takeda Bigot, Noemie: None. Mary, Jean-Yves: none Lambert, Jérome: none Colombel, Jean-Frédéric: Grant: AbbVie, Janssen Pharmaceuticals, Takeda, Prometheus and Bristol Myers Squibb Lectures from: AbbVie, Roche and Takeda Other: AbbVie, Amgen, AnaptysBio, Allergan, Apini, Arena Pharmaceuticals, Astellas, Boehringer Ingelheim, Bristol Myers Squibb, candidrx Celgene, Celltrion, Clearview Curogen, Eli Lilly, Envision Pharma Ferring Pharmaceuticals, Galmed Research, Glaxo Smith Kline, Roche, Janssen Pharmaceuticals, Kaleido Biosciences, Immunic, Iterative Scopes, Landos, Microba Life Science, Merck, Mirador, Novartis, Otsuka Pharmaceutical, Owkin, Pfizer, Protagonist Therapeutics, Sanofi, Sun Pharma, Takeda, Teva, TiGenix, and is holding stock options in Intestinal Biotech Development Buisson, Anthony: Grant: Abbvie, Celltrion, Pfizer and Takeda Personal Fees: Abbvie, Amgen, Arena, Biogen, Celltrion, Ferring, Janssen, MSD, Pfizer, Roche, Sanofi-Aventis, Takeda, Tillotts, Vifor Pharma, Tinoco da Silva Torres, Joana: Grant: Abbvie, Janssen Personal Fees: Pfizer, Janssen, Abbvie, Sandoz, Lilly, Sanofi, Takeda Non-financial Support: Janssen, Abbvie