P0547 - Histologic Activity Does Not Predict Future Recurrence in Postoperative Crohn’s Disease

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Award: Presidential Poster Award

Presenting Author(s)

Ravi S. Shah, MD

Digestive Disease Institute, Cleveland Clinic Foundation
Cleveland, OH, United States

Award: Presidential Poster Award

Ravi S. Shah, MD¹, Salam P. Bachour, MS², Amy L. Lightner, MD¹, Stefan D. Holubar, MD¹, Miguel Regueiro, MD³, Florian Rieder, MD⁴, Benjamin Cohen, MD, MAS³, Edward L. Barnes, MD, MPH⁵, Jordan Axelrad, MD, MPH⁶, Benjamin Click, MD, MS¹
¹Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic Lerner College of Medicine, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH; ⁴Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH; ⁵University of North Carolina Chapel Hill, Chapel Hill, NC; ⁶New York University School of Medicine, New York, NY

Introduction: Postoperative recurrence (POR) of Crohn’s disease (CD) following ileocecal resection (ICR) is common. Endoscopic CD activity guides postoperative management. Histologic activity precedes endoscopic activity. In patients in endoscopic remission, the influence of histologic activity on risk of subsequent POR is unknown. We aimed to assess the impact of histologic activity on subsequent endoscopic POR in CD individuals in endoscopic remission following ICR.

Methods: Adult CD patients who underwent ICR between the years 2009 to 2020 with no active disease (Rutgeerts’ i0) on index colonoscopy with biopsies of the neoterminal ileum or anastomosis were included. Those without a follow up after the first endoscopy were excluded. The rate of composite POR, including endoscopic (≥i2b disease), radiologic, surgical, and pharmacologic recurrence (i.e. change in treatment), was compared between patients with histologic activity versus quiescence using chi-square and Kaplan-Meier survival analysis curves. Cox proportional hazard modeling was used to compare histologic activity to high-risk features of surgical recurrence and use of postoperative biologic prophylaxis.

Results: There were 79 CD patients (Mean age 34 years, 49.4% ileocolonic disease, 71.2% stricturing, 34.5% ≥1 prior ICR, 27.8% active smoking, and 25.3% treated with postoperative biologic prophylaxis) with i0 disease and random endoscopic biopsies after ICR that were included. Overall composite recurrence rate was 58.2% over median follow up of 1242 days. Histologic activity was not associated with composite POR (p=0.49) including endoscopic (p=0.50), radiologic (0.99), surgical (0.78), or pharmacologic recurrences (Biologic: p=0.59; Immunomodulator: p=0.99; Steroid POR: p=0.54). Composite POR was not significantly different by histologic activity group (p=0.29) (Figure 1). Adjusting for high risk predictive factors of POR, histologic activity was not associated with composite POR (HR 1.71 (0.92-3.21); p=0.09). While active smoking was significantly associated (HR 2.29 (1.11-4.72); p=0.025) with composite POR, postoperative biologic prophylaxis was protective (HR 0.41 (0.20-0.81); p=0.01) (Table 1).

Discussion: Histologic activity in endoscopically normal exam is not associated with endoscopic, radiologic, surgical, and pharmacologic postoperative recurrences. Future studies are required to assess the utility of endoscopic biopsies in CD patients with i0 disease to better guide the management of postoperative CD.

Figure: Figure 1. Kaplan Meier survival analysis of time to composite postoperative recurrence in CD Patients in remission with histologically active versus quiescent disease.

	Adjusted Hazard Ratio (95% CI)	P value
Histologic Activity	1.71 (0.92-3.21)	0.09
Tobacco (Reference: Never)	--	--
Former	1.83 (0.79-4.21)	0.16
Active	2.29 (1.11-4.72)	0.025
≥2 prior ileocecal resections	1.02 (0.42-2.48)	0.97
Use of postoperative biologic prior to index endoscopy	0.41 (0.20-0.81)	0.01

Table: Table 1. COX Proportional Hazard Model of Composite Postoperative Recurrence.

Disclosures:

Ravi Shah indicated no relevant financial relationships.

Salam Bachour indicated no relevant financial relationships.

Amy Lightner: Takeda – Consultant.

Stefan Holubar: Guidepoint – Consultant. Takeda – Consultant.

Miguel Regueiro: Abbvie – Consultant. ALFASIGMA – Consultant. Allergan – Consultant. Amgen – Consultant. Bristol Meyer Squibb – Consultant. Celegene – Consultant. Genentech – Consultant. Gilead – Consultant. Janssen – Consultant. Lilly – Consultant. Miraca Labs – Consultant. Pfizer – Consultant. Prometheus – Consultant. S.p.A. – Consultant. Salix – Consultant. Seres – Consultant. Takeda – Consultant. TARGET Pharma Solutions – Consultant. UCB – Consultant.

Florian Rieder: Abbvie – Consultant, Grant/Research Support. Adnovate – Consultant. Agomab – Consultant. Allergan – Consultant. BMS – Grant/Research Support. Boehringer Ingelheim – Grant/Research Support. Boehringer-Ingelheim – Consultant. CDISC – Consultant. Celgene/BMS – Consultant. Cowen – Consultant. Crohn’s and Colitis Foundation – Grant/Research Support. Galmed – Consultant. Genentech – Consultant. Gilead – Consultant. Gossamer – Consultant. Guidepoint – Consultant. Helmsley – Consultant. Helmsley Charitable Trust – Grant/Research Support. Index Pharma – Consultant. Jannsen – Consultant. Kenneth Rainin Foundation – Grant/Research Support. Koutif – Consultant. Mestag – Consultant. Metacrine – Consultant. Morphic – Consultant, Grant/Research Support. NIH – Grant/Research Support. Organovo – Consultant. Origo – Consultant. Pfizer – Consultant, Grant/Research Support. Pliant – Consultant. Pliant – Grant/Research Support. Prometheus Biosciences – Consultant. Receptos – Consultant. RedX – Consultant. Roche – Consultant. Surmodics – Consultant. Surrozen – Consultant. Takeda – Consultant. Techlab – Consultant. Theravance – Consultant. Thetis – Consultant. Thetis – Consultant. UCB – Consultant, Grant/Research Support. Ysios – Consultant.

Benjamin Cohen: Abbvie – Consultant. Celgene-Bristol Myers Squibb – Consultant. Pfizer – Consultant. Sublimity Therapeutics – Consultant. Takeda – Consultant. TARGET RWE – Consultant.

Edward Barnes: AbbVie – Consultant. Gilead – Consultant. Pfizer – Consultant. TARGET-RWE – Consultant.

Jordan Axelrad: BioFire Diagnostics – Consultant, Grant/Research Support. Janssen – Consultant.

Benjamin Click indicated no relevant financial relationships.

Ravi S. Shah, MD¹, Salam P. Bachour, MS², Amy L. Lightner, MD¹, Stefan D. Holubar, MD¹, Miguel Regueiro, MD³, Florian Rieder, MD⁴, Benjamin Cohen, MD, MAS³, Edward L. Barnes, MD, MPH⁵, Jordan Axelrad, MD, MPH⁶, Benjamin Click, MD, MS¹. P0547 - Histologic Activity Does Not Predict Future Recurrence in Postoperative Crohn’s Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.