DOP006 Ileocaecal resection versus infliximab for ileal Crohn’s disease: 10-year follow-up of the LIR!C trial

Background The LIR!C trial demonstrated that laparoscopic ileocaecal resection (ICR) is an effective alternative to infliximab therapy (IFX) in patients with uncomplicated ileocaecal Crohn’s disease (CD) failing conventional treatment, with comparable quality-of-life outcomes. [1,2] We aimed to assess the 10-year outcomes of the LIR!C trial, focusing on the long-term therapy-free and clinical remission rates of both interventions. Methods This cohort study included patients from the LIR!C trial, a multicentre randomised controlled trial comparing ICR to IFX treatment in patients with ileal CD. Long-term data were retrospectively collected between February 3 and July 17, 2025, including initiation or switch of CD-related treatments and (re-)resections. Follow-up ranged from trial enrolment to the latest visit with the gastroenterologist or surgeon. Outcomes of interest were (i) therapy-free remission rates, defined as clinical remission without the initiation of CD-related therapy in the ICR group and discontinuation of IFX in the IFX group, and compared between groups using bootstrapping; and (ii) clinical remission rates, defined as the absence of changes in CD-related therapy or the need for additional resection in both groups, and compared between groups using Cox regression. Flexible parametric survival modelling was used to investigate potential age-dependent effect modification of ICR vs IFX for 10-year clinical remission rates. Results Sufficient follow-up data were available from 66/69 ICR patients and 63/65 IFX patients. The median follow-up time was 11 years (IQR 9–14). The 10-year therapy-free remission rate was 35·8% (95% CI 25·6–50·1) in the ICR group, compared to 13·2% (6.1–23.1) in the IFX group (difference, 22·6% [95% CI 7.8–36.8]; p = 0·004). Although overall 10-year clinical remission rates were similar in the ICR and IFX groups (36·5% vs 28·4%; hazard ratio, 0.79 [95% CI 0.52 to 1.20]; p = 0·27), interaction analyses showed an age-dependent effect of ICR on clinical remission rates (pinteraction sss= 0·020) and a significant treatment benefit with ICR for younger patients. The estimated 10-year clinical remission rates for a 20-year-old patient were 54% with ICR vs 24% with IFX (difference, 30% [7 to 53]), compared to 38% vs 28% for a 30-year-old patient (difference, 10% [–6 to 26]). Conclusion This study shows superior 10-year therapy-free remission rates with ICR and a greater benefit in terms of sustained clinical remission in younger patients. These findings support early ICR as an attractive treatment option for ileal CD in the early disease course. References: 1.Ponsioen, C.Y., et al., Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol, 2017. 2(11): p. 785-792. 2.Stevens, T.W., et al., Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: retrospective long-term follow-up of the LIR!C trial. Lancet Gastroenterol Hepatol, 2020. 5(10): p. 900-907. Conflict of interest: Haanappel, Anouck: No conflict of interest Oldenburg, Lotte: none Ali, Mahsoem: No conflict of interest Bosman, Carolijn: No conflict of interest Buskens, Christianne J.: Grant: C. Buskens has received an unrestricted grant from Boehringer Ingelheim and Roche Personal Fees: C. Buskens has received consultancy fees and/or speaker’s honoraria from Tillotts, Takeda, MSD and Janssen Ponsioen, Cyriel: No conflict of interest D’Haens, Geert: Grant: Pfizer, BMS, Johnson and Johnson, Abbvie, Alimentiv BV, Eli Lilly, Takeda, Prometheus Laboratories Personal Fees: Abbvie, Abivax, Agomab, Alimentiv, Anaptys Bio, AstraZeneca, Bristol Meiers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Exeliom Biosciences, Galapagos, Glaxo Smith Kline, Dr Falk Pharma, Pfizer, Johnson and Johnson, Merck, Mirador, Polpharma, Procise Diagnostics, Prometheus Biosciences, Sorriso Pharma, Spyre, Takeda, Ventyx Bemelman, Willem: Other: Speakersfees from Applied 4.9% shares Semiflex bv