S31 The Impact of Early vs Late Biologic Initiation Among Real-World Patients With Crohn’s Disease in TARGET-IBD

Background: Crohn’s disease is a chronic, progressive inflammatory condition that affects both adult and pediatric populations and has an increasing prevalence worldwide. The objective of this study was to investigate the link between time-to-initiation of biologics and endpoint risk among adult patients with Crohn’s Disease (CD). Methods: TARGET-IBD is a prospective longitudinal cohort of over 4,474 IBD patients receiving care at 34 US academic or community centers in the US enrolled between June 2016 and February 2022. All patients with a CD diagnosis in the TARGET-IBD cohort were eligible if they initiated a biologic therapy in the retrospective or prospective follow-up periods. Biologics included anti-TNF therapies (adalimumab, infliximab, certolizumab pegol), vedolizumab, and ustekinumab. Patients with a total colectomy before treatment initiation, patients diagnosed as having ulcerative colitis, patients whose earliest known clinical assessment occurred prior to the retrospective period, and IBD patients consistently classed as IBD-U (IBD-unclassified) type were excluded. Multivariable probit and Cox proportional hazard models were used to estimate the impact of biologic timing on primary endpoints: the proportion of patients who undergo IBD surgery/procedure or experience disease progression (i.e., change in Crohn’s phenotype from B1 to B2/3). Results: Of the 4,474 adult patients enrolled in TARGET-IBD, 611 CD patients were included in the analysis. The risk of undergoing surgery was significantly higher for individuals who initiated a biologic 2 to 5 years following CD diagnosis, in whom 30 percent requiring surgery within 20 months of diagnosis. Similarly, the risk of disease progression decreased with an early biologic initiation; those starting a biologic within 1 month of diagnosis had the lowest risk (15%). In contrast, of patients who initiated a biologic 2 to 5 years following diagnosis, approximately 50 percent had disease progression by 20 months following diagnosis and nearly 60 percent had evidence of disease progression by 60 months. Conclusion(s): In a comparison of time to initiating a biological therapy, CD patients who began biologics closer to their diagnosis had a lower risk of surgery as well as disease progression, supporting the importance of biologic use early in the management of patients with CD.