S1691 Treat-to-Target Gaps in Crohn’s Disease: Insights From Real-World Practice

Introduction: Treat-to-target strategies in Crohn’s disease (CD) emphasize objective monitoring to assess therapeutic response and guide early therapeutic escalation. However, data on real-world application of treat-to-target recommendations remains limited. We evaluated post-treatment monitoring, remission, and treatment patterns during the first year after initiation of advanced therapy (AT) for CD. Methods: We analyzed data from TARGET-IBD, a longitudinal U.S. registry of patients with clinician-diagnosed IBD. Adult patients initiating a new AT (anti-IL-12/23, anti-integrin, anti-TNF, JAK inhibitors, S1P modulators) between October 2014 and September 2021 were included for follow-up. Objective reassessment was defined as endoscopy or fecal calprotectin (FC) testing within 12 months. Remission was evaluated at 2–4 and 10–14 months post-initiation (mimicking induction and maintenance windows in clinical trials). Outcomes included endoscopic remission (SES-CD 0–4, or 0–3 for ileal-only disease, or narrative indication of inactive disease) and corticosteroid-free remission (no systemic corticosteroid use in the 14 days before endoscopy), overall and by line of advanced therapy (first-line [1L] AT vs second-line or later [2L+] AT). Treatment persistence and corticosteroid use were also summarized. Results: Among 1189 CD patients, 38% underwent objective reassessment within 12 months; FC testing was rare (12%). At AT initiation, 39% had inflammatory CD, 35% fistulizing, and 27% stricturing disease. Ileocolonic disease was most common (56%), followed by isolated ileal (27%) and colonic (17%). At 2–4 months, only 55 patients (5%) underwent endoscopy: 31% achieved endoscopic remission and 26% corticosteroid-free remission. At 10–14 months, 156 patients (13%) underwent endoscopy: 45% achieved endoscopic remission and 39% corticosteroid-free remission. At this time window, remission proportions were higher for patients on 1L AT compared to 2L+ AT. Among patients with endoscopy at 10-14 months, 46% required at least one corticosteroid prescription after initiating AT. At 10-14 months, 33% had switched or discontinued their initial AT. Conclusion: In this national registry cohort of CD patients initiating a new AT, objective monitoring was infrequent, and corticosteroid use was high over the first year. Remission rates were modest, and many patients required treatment changes. These findings highlight real-world gaps in treat-to-target implementation and early care optimization.