P456 Magnetic resonance enterography findings at week 46 after biological treatment predict long-term clinical outcomes in Crohn's disease patients
Fernandez Clotet, A.(1)*;Ordás, I.(2);Masamunt, M.C.(3);Caballol, B.(3);Rodriguez, S.(4);Panés, J.(3);Ricart, E.(5);Rimola, J.(4);
(1)IBD Unit. Hospital Clinic de Barcelona, Gastroenterology, Barcelona, Spain;(2)IBD Unit. Hospital Clinic de Barcelona, Gastroenteroloy, Barcelona, Spain;(3)IBD Unit- Hospital Clinic de Barcelona, Gastroenterology, Barcelona, Spain;(4)IBD Unit- Hospital Clinic de Barcelona, Radiology, Barcelona, Spain;(5)IBD Unit- Hospital Clinic de Barcelona, Gasteroenterology, Barcelona, Spain;
Background
Magnetic resonance enterography (MRE) provides an accurate evaluation of transmural lesions in Crohn's Disease (CD). However, MRE findings associated with poor long-term outcomes in CD are not yet defined. Identification of such parameters would help in defining therapeutic goals.
AIMS: to identify predictors of long-term clinical outcomes based on MRE findings performed 46 weeks after biological treatment initiation in patients with CD.
Methods
single-center, prospective, longitudinal study conducted from 2010 to 2019. Patients with CD who had an MRE evaluation 46 weeks after biological treatment initiation and clinical follow-up of at least 3 years were evaluated.
Results
89 patients were included with a median follow up of 53 months (IQR 44-76). 59 patients had ileal (66.3%), 26 ileocolic (29.2%) and 4 colonic disease (4.5%). 31 (34.8%) had inflammatory behavior, 27 (30.3%) stricturing, 9 (10.1%) fistulizing and 22 (34.7%) stricturing/fistulizing. 70 (78.7%) were treated with anti-TNFα, 5 (5.6%) vedolizumab and 14 (15.7%) ustekinumab. During follow-up, 25 (28.1%) required surgery, 17 (19.1%) hospitalization, 40 (44.9%) had clinical relapse (CDAI >150), 12 (13.5%) required corticosteroids and 12 (13.5%) required endoscopic dilatation. 32 (36.0%) patients needed resection surgery or endoscopic dilatation. MaRIA score ≥11 in any segment at week 46 was associated with a higher risk of surgery [HR 6.28 (1.42-27.84), p=0,02] or surgery/endoscopic dilatation [HR 3.76 (1.24-11.38), p=0,02]. Relative contrast enhancement (RCE) >103 was associated with higher risk of clinical relapse [HR 1,01 (1.00-1.02), p=0,03] and corticosteroids requirement [HR 1,01 (1.00-1.02), p=0,05].
Conclusion
MRE findings at week 46 after biological treatment initiation predict long-term clinical outcomes in CD patients. The main determinants of poor clinical prognosis were MaRIA score ≥11 and RCE >103. Patients with these persistent findings may be candidates for treatment optimization.