S2008 Real-World Assessment of Risankizumab in Preventing Post-Operative Recurrence of Crohn’s Disease: A Comparison to Ustekinumab and Anti-TNF

Introduction: Post-operative recurrence (POR) of Crohn’s disease (CD) is common and current guidelines recommend postoperative therapy in high-risk patients. We evaluated the effectiveness of risankizumab (RZB) in POR of CD following ileal, colonic, or ileocolonic resection and compared it to ustekinumab (UST) and anti-tumor necrosis factor (TNF). Methods: This is a retrospective review of prospectively collected real-world data from 2019-2025 of patients (pts) with CD who underwent surgical resection and initiated postoperative therapy with RZB, UST, or anti-TNF within 6 months (m) of surgery. The primary endpoint was endoscopic remission (defined as Rutgeerts < i2) within 6-12 m following surgery. Secondary outcomes included remission as measured by Harvey-Bradshaw Index ≤4, C-reactive protein <3 mg/L or fecal calprotectin ≤150 μg/g), or cross-sectional imaging. Results: Of 115 pts with CD (59% women) who underwent resection, the median age at diagnosis was 22.26 y [IQR 17.2-29.4], median age at surgery was 34.8 y [IQR 27.2-48.7], and median duration from diagnosis to surgery was 11.2 y [IQR 4.6-18.0]. Post-op treatments included RZB (n = 35), UST (n = 36), and anti-TNF (n = 44). Most patients were advanced treatment experienced. There was no significant difference in endoscopic postoperative remission among RZB, UST, and anti-TNF therapies (RZB: 20 [74.1%], UST: 25 [83.2%], anti-TNF: 32 [86.5%]; P = 0.34 for RZB vs anti-TNF, P = 0.36 for RZB vs UST). There was no significant difference in POR-free survival among the 3 groups (P = 0.41, Kaplan-Meyer). Cross-sectional imaging remission was more frequent with RZB compared to UST (12 [63.2%] vs 2 [22.2%], P = 0.05), but not compared to anti-TNF (7 [63.6%], P = 1.00). In univariate and multivariate logistic regression of all patients, younger age at surgery (P = 0.03, OR 0.96) and prior use of 3 or more advanced therapies (P = 0.04, OR 0.32) were predictors of post-operative recurrence. Only one pt on RZB reported arthralgia as treatment-related AE. Conclusion: This is the first report of RZB for prevention of POR in CD. We found no significant differences in endoscopic POR in pts treated with RZB compared to UST or anti-TNF. Across all pts in this analysis, younger age at surgery and prior use of 3 or more advanced therapies were predictors of 6-12 m POR, underscoring the importance of post operative prophylaxis in high-risk patients. Our results suggest that RZB is an effective and safe option for post-operative prevention of CD.