Early advanced therapies and real-world outcomes in Crohn's disease: A population-based comparison of two incident cohorts in Navarra.

Objective: The introduction of biologic therapies has transformed the management of Crohn's disease (CD), yet few studies have evaluated their impact on real-world outcomes over time. We aimed to compare two population-based cohorts of CD patients in Navarra, Spain, diagnosed in 2001-2003 (cohort A) and in 2017 (cohort B), to assess whether early use of advanced therapies has altered disease trajectory.

Patients and methods: This prospective, multicentre cohort study included adult patients with confirmed CD from two periods. Clinical characteristics, treatments, hospitalizations, and surgical outcomes were analysed over five years. Time-to-event analyses were performed using Kaplan-Meier curves and Cox regression models.

Results: A total of 128 patients were included (83 in cohort A, 45 in cohort B). At diagnosis, immunomodulators were used in 1.2% of cohort A vs. 21% in cohort B, and biologics in 0% vs. 51%, respectively. Initiation of immunomodulators (hazard ratio [HR]: 1.94; 95% CI: 1.11-3.39) and biologics (HR: 5.42; 95% CI: 2.57-11.42) occurred earlier in cohort B. Hospitalization at diagnosis was more frequent in cohort A (47% vs. 22%), and five-year hospitalization rates were significantly lower in cohort B (34% vs. 63%; HR: 0.52; 95% CI: 0.28-0.96). No significant differences in intestinal or perianal surgery rates were observed between cohorts.

Conclusions: Earlier and more widespread use of advanced therapies in CD has been associated with reduced hospitalization over time, although surgical rates have remained stable. These findings suggest a shift toward earlier and more intensive treatment strategies in routine clinical practice.