P0846Sustained Long-Term Improvement of Bowel Urgency in IBD Patients Treated With Advanced Therapies: a Multicentre Study

Abstract Background Bowel urgency (BU) affects over 80% of patients with ulcerative colitis (UC) and 60% of those with Crohn’s disease (CD). While available evidence indicates that advanced therapies may improve BU, data on sustained BU remission remain limited. This study aimed to evaluate the impact of advanced therapies on BU improvement and sustained BU remission in UC and CD. Methods We conducted a retrospective cohort study at two tertiary centers (IRCCS San Raffaele Hospital and University of Naples Federico II) between April 2023 and November 2025. Consecutive patients with confirmed UC or CD who initiated an advanced therapy (biologic or small-molecule agent) and had BU data available at baseline, post-induction, and 12 months were included. BU was assessed using the Numeric Rating Scale urgency score (NRS-us), with BU defined as NRS-us ≥3. Collected variables included clinical indices (partial Mayo score for UC; Harvey–Bradshaw Index for CD), biochemical markers (fecal calprotectin (FC) and C-reactive protein), endoscopic scores (Mayo endoscopic score or SES-CD), and intestinal ultrasound parameters. Patients with prior bowel surgery or radiotherapy were excluded. The primary endpoint was BU improvement at 12 months, defined as NRS-us ≤3 or a reduction of ≥ 2 points. A multivariate logistic regression was performed to identify associations between baseline factors and NRS-us changes, with false-discovery-rate correction applied. Results A total of 305 patients were included (53.1% male; median age 39 years; median BMI 22.1; 64.6% UC). Most received ustekinumab (22.0%), infliximab (21.6%), adalimumab (20.3%), or a small-molecule therapy (13.8%). Median baseline NRS-us was 7. After induction, 158 patients (51.6%) showed BU improvement (mean NRS-us reduction 2.3 ± 2.9). At 12 months, 133 patients (43.2%) achieved BU improvement, with a median NRS-us of 3. Sustained BU improvement at week 52 was observed in 61 patients (22.3%) who had responded at week 12, while 72 additional patients (26.3%) achieved BU improvement only by week 52. Conversely, 57 patients (20.8%) who initially improved no longer demonstrated meaningful BU improvement at week 52. In multivariate analyses, BU improvement at all timepoints was associated with clinical remission (p 0.0001) and FC normalization (p 0.01). BU remission at weeks 12 and 24 also correlated with intestinal ultrasound remission (p = 0.02 and p = 0.002). No significant differences in BU outcomes were observed among therapies. Conclusion Advanced therapies are effective in achieving long-term BU improvement in UC and CD. BU improvement is strongly associated with clinical, biochemical, and ultrasound remission. Conflict of interest: D’Amico, Ferdinando: Grant: ECCO fellowship grant 2020 ECCO grant 2021 Personal Fees: F D’Amico has served as a speaker for Abbvie, Alfasigma, Ferring, Lilly, Sandoz, Janssen, Fresenius Kabi, Galapagos, Giuliani, MSD, Pfizer, Takeda, Tillotts, and Omega Pharma he also served as an advisory board member for Abbvie, AnaptysBio, Ferring, Fresenius Kabi, Galapagos, Janssen, Lilly, MSD, Takeda, and Nestlè. Nardone, Olga Maria: Advisory board fees from Eli Lilly, Nestlè, Janssen Speaker fees from AbbVie, Janssen, Eli Lilly, Ferring, Alfa Sigma, Recordati, Noòs, and Pfizer Dr. Bruno, Alessandro: No conflict of interest El Khoury, Raffaella: No conflict of interest Allocca, Mariangela: Personal Fees: consulting fees from Nikkiso Europe, Mundipharma, Janssen, Abbvie, Pfizer, Ferring, Galapagos, Sandoz, Lilly and Alfasigma Zilli, Alessandra: Personal Fees: Speaking and consulting fees from Tillotts, Galapagos, Abbvie, Takeda, Janssen, Alfasigma, Sandoz, Lilly, Pfizer Furfaro, Federica: Grant: IG-IBD Personal Fees: Pfizer, Biogen, J&J, Abbvie, Amgen, Janssen Parigi, Tommaso Lorenzo: No conflict of interest Solitano, Virginia: Speaker’s fees from Pfizer, Takeda, Giuliani, Tillotts Pharma consulting fees from J & J travel grant from Abbvie La Mantia, Alessia: No conflict of interest Calabrese, Giulio: Travel grant by Johnson and Johnson Speaker fee by Celltrion Fiorino, Gionata: Personal Fees: Takeda, Johnson & Johnson, Alfasigma, AbbVie, Celltrion, Pfizer, Sandoz, Abivax, Lilly, STADA Jairath, Vipul: Consulting Fees: Abbvie, Alimentiv, Amgen, Anaptys Bio, Asahi Kasei, Asieris, Astra Zeneca, Attovia, Blackbird Labs, BMS, Boehringer Ingleheim, Biomebank, Caldera, Calluna, Catalytic Health, Celltrion, Ensho, Enthera, Exeliome Biosciences, Ferring, Fresenius Kabi, Gilead, Granite Bio, GSK, Janssen, Lilly, Merck, Mountainfield, MRM Health, Nxera, Organon, OSE Immunotherapeutics, Pendopharm, Pioneering Medicine, Pfizer, Prometheus, Roche/Genentech, Sanofi, SCOPE, Shattuck Labs, Sorriso, Spyre, Synedgen, Takeda, Teva, Tillotts, Union Therapeutics, Ventus, Ventyx, Vividion, Xencor, Zealand Pharma. Peyrin-Biroulet, Laurent: CONSULTING Abbvie, Abivax, Adacyte, Alimentiv, Alfasigma, Amgen, Apini, Banook, BMS, Celltrion, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, Iterative Health, Janssen, Lilly, LifeMine, Medac, Morphic, MSD, Nordic Pharma, Novartis, Oncodesign Precision Medicine, ONO Pharma, OSE Immunotherapeuthics, Par’ Immune, Pfizer, Prometheus, Roche, Roivant, Samsung, Sandoz, Sanofi, Sorriso, Spyre, Takeda, Teva, ThirtyfiveBio, Tillots, Vectivbio, Vedanta, Ventyx. LECTURE Abbvie, Alfasigma, Amgen, Biogen, Celltrion, Ferring, Galapagos, Genentech, Gilead, Iterative Health, Janssen, Lilly, Medac, MSD, Nordic Pharma, Pfizer, Sandoz, Takeda, Tillots Massimino, Luca: No conflict of interest Castiglione, Fabiana: Honoraria from: Takeda, AbbVie, Celltrion, Johnsson Johnsson, Cadigroup, Sandoz, Pfizer, Lilly, Lionhealth, Nestlè Danese, Silvio: Personal Fees: AbbVie, Alimentiv, Allergan, Amgen, Applied Molecular Transport, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Dr Falk Pharma, Eli Lilly, Enthera, Ferring Pharmaceuticals Inc., Gilead, Hospira, Inotrem, Janssen, Johnson & Johnson, Morphic, MSD, Mundipharma, Mylan, Pfizer, Roche, Sandoz, Sublimity Therapeutics, Takeda, Teladoc Health, TiGenix, UCB Inc., Vial, Vifor Lecture fees from Abbvie, Amgen, Ferring Pharmaceuticals Inc., Gilead, Janssen, Mylan, Pfizer, Takeda