Comparative Effectiveness of Biologics for Endoscopic Healing of the Ileum and Colon in Crohn’s Disease

Crohn’s disease (CD) is a type of inflammatory bowel disease that is characterized by periods of relapse and remission and affects nearly 300,000 Canadians. CD affects any area of the gastrointestinal tract but is more common in the ileum and colon. Healing of ulcers is an important treatment target in CD, and is defined as endoscopic healing (EH). The Simple Endoscopic Score for CD (SES-CD) is a validated tool used to quantify mucosal inflammation in CD via endoscopy and is used to define EH. Biologics are medications used to treat patients with moderate to severe CD. To obtain regulatory approval, biologics must demonstrate the ability to heal ulcers in clinical trials of CD. Biologics approved for CD include adalimumab, ustekinumab, infliximab, and vedolizumab. Previous studies have demonstrated EH is not linear across the segments of the colon and the ileum and may be more difficult to achieve in the ileum and rectum. However, the comparative effectiveness of approved biologics for CD for achieving segment-specific EH has not been reported. The primary objective of this study is to compare the efficacy of four approved biologics for CD on endoscopic healing of the ileum and individual segments of the colon at week 52.