P332 A treat-to target strategy guided by pan-enteric valuation in paediatric Crohn’s disease improves outcomes at 2 years

Abstract

Objectives and Study: Sparse data exist on the long-term outcomes of mucosal healing (MH) in children with Crohn's disease (CD). It is uncertain if a treat-to-target approach might be a clinically and cost-effective strategy improving deep remission (DR) rate and outcomes. Previously, we reported MH and DR rates on the entire GI tract by performing three pan-enteric capsule evaluations and applying a treat-to-target strategy over 52 weeks in children with CD. This study evaluates the impact of this approach at 104-weeks. Method(s): Children with known CD were prospectively recruited and underwent pan-enteric capsule endoscopy (PCE) at 0, 24, 52 and 104 weeks. Therapy was calibrated according to PCE and magnetic resonance enterography (MRE) results in a treat-to-target approach. Results at week 52 and 104 were compared, and long-term outcomes between patients with or without complete MH were calculated using an intention-to-treat (ITT) analysis of clinical relapse, need for steroids and/or treatment escalation, hospitalization and surgery. Result(s): Forty-eight patients (pts) were recruited at baseline and underwent a treat-to-target approach for one year. The 52-week assessment demonstrated a 58% DR rate compared to 21% of baseline (p< 0.05). In all, 42 underwent the 104-week PCE evaluation (2 developed an ileo-cecal valve stricture at 52 weeks; 4 were lost to follow-up). MH was present in 10 at baseline; 28 at 52 weeks. There was only 7% drop-off in MH compared with 1-year assessment. In ITT analysis, complete MH at 52 weeks was associated with decreased clinical relapse rate (p< 0.003), reduced steroid usage (p< 0.0005), fewer treatment escalation (p< 0.0003), and diminished hospitalization rates (p< 0.0001). There was a decreased need for surgery, but not statistically significant (p=0.065). The overall diagnostic yield of PCE, MRE and biomarkers were 54%, 37% and 33%, respectively (p< 0.05). Conclusion(s): Treat-to-target approach can significantly increase DR rates on the entire GI tract by using PCE and it seems to be cost-effective. When MH is achieved by this strategy, it is sustainable (93%) over a one-year period and correlates with improved patient outcomes, including decreased need for steroids, treatment escalation, hospitalization and surgery.