DOP132Disease course of Crohn’s disease after ileocecal resection in the era of biologics: a binational population-based cohort study

Abstract Background While population-based studies have evaluated Crohn’s disease (CD) outcomes after ileocecal resection (ICR), data in the era of biologics remain limited. This study assessed the long-term disease course, including treatment exposure, hospitalizations, and surgery, in CD patients undergoing ICR. Methods We conducted two nationwide cohort studies comprising all patients with CD aged over 18 years and undergoing a first ICR without protective ileostomy in Denmark (Danish registries, 1995–2023) and France (French administrative healthcare databases, 2010–2023). Baseline characteristics including CD phenotype, treatment history, and comorbidities were assessed at the date of ICR. Prophylactic treatment initiation was assessed within 90 days post-ICR. Patients were followed from 90 days post-ICR until death or December 31, 2024. Primary outcomes were 10-year cumulative risks of: (1) major gastrointestinal (GI) surgery, (2) CD-related hospitalization, (3) initiation of immunosuppressant/advanced therapy (switch if started within 90 days post-ICR), and (4) corticosteroids initiation. Results The cohorts included 2,358 and 10,426 patients in Denmark and France, contributing to 29,049 and 75,323 person-years of follow-up, respectively. Median age at ICR was 34.0 (IQR, 25.0-48.3) and 37.8 (IQR, 28.3-51.1), with median CD duration of 1.2 (IQR, 0.2-5.0) and 4.5 (IQR, 1.0-10.8) years. Pre-ICR, 29.5% (n = 696) and 54.5% (n = 5681) of patients had received at least one advanced therapy in Denmark and France. Post-ICR prophylactic treatment (immunosuppressant or advanced therapy) was initiated in 24.9% (n = 587) and 29.3% (n = 3051) of patients. At 10 years, the cumulative risk of major GI surgery was of 20.8% (95%CI, 18.8-22.6) in Denmark and 9.7% (95%CI, 8.9-10.5) in France (Figure 1). When restricted to 2010-2023 in Denmark, the 10-year cumulative risk of major GI surgery was of 13.2% (95%CI, 10.3-16.0). The 10-year cumulative risk of initiating immunosuppressant or advanced therapy reached 57.8% (95%CI, 55.6-59.9) and 66.8% (95%CI, 65.7-67.8) in Denmark and France, respectively. When stratified by the year of ICR (±2017), a decrease in the risk of major GI surgery was observed in Denmark but not in France. 20.9% (n = 309) of Danish and 15.2% (n = 1593) of French patients remained free of corticosteroids, immunosuppressant or advanced therapy (or switch if started within 90 days post-ICR), CD-related hospitalization, or major GI surgery at 10 years. Conclusion In the era of biologics, the 10-year cumulative risk of second major GI surgery after ICR remains substantial, ranging from 10 to 20%. However, 15% to 20% of patients achieve sustained remission without further intervention, warranting deeper investigation into predictors of this favorable outcome. Conflict of interest: Vestergaard, Marie Vibeke: No conflict of interest Challine, Alexandre: No conflict of interest Allez, Matthieu: Grant: Janssen, Genentech/Roche, Takeda Personal Fees: Abbvie, Amgen, Astra-Zeneca, Biogen, Boehringer-Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Ferring, Galapagos, Genentech, Gilead, IQVIA, Janssen, Novartis, Pfizer, Spyre therapeutics, Roche, Takeda, Tillots Agrawal, Manasi: No conflict of interest Bezault, Madeleine: No conflict of interest Lie, Mads: No conflict of interest Picker, Mellissa: No conflict of interest Satsangi, Jack: Grant: Grants to Oxford University from Helmsley Trust & European Community. Uhlig, Holm: No conflict of interest 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 Jess, Tine: Personal Fees: Consultancy for Ferring, Pfizer, Johnson & Johnson Kirchgesner, Julien: Lecture fees and/or consulting fees from from Abbvie, Amgen, Astrazeneca, Celltrion, Galapagos, Janssen, Lilly, MSD, Takeda, Tillots, Pfizer.