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

A. Haanappel, L. Oldenburg, M. Ali, C. Bosman, C.J. Buskens, C. Ponsioen, G. D’Haens, W. Bemelman, LIR!C study group

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Slides compiled by Dr. Cynthia Seow 

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Introduction

Background & Objectives

    • The LIR!C trial demonstrated laparoscopic ileocaecal resection (ICR) as a viable alternative to infliximab (IFX) for uncomplicated ileal Crohn’s disease after failure of conventional therapy, with similar quality-of-life outcomes at 1 and 5 years.
    • Objective: Determine therapy-free remission and clinical remission rates following ICR vs IFX at 10 years.

CD, Crohn’s disease; ICR, ileocaecal resection; IFX, infliximab.

Haanappel A et al. ECCO 26; (Abstract citation ID: jjaf231.043, DOP006).

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Methods

    • Design: Cohort study derived from the LIR!C multicentre randomized controlled trial comparing ICR vs IFX in ileal CD.
    • Data collection: Retrospective assessment of long-term outcomes (Feb 3–Jul 17, 2025), including CD treatment initiation or switch, and need for repeat resection.
    • Outcomes of Interest:
      • Therapy-free remission:
        • ICR group: clinical remission without initiation of CD-related therapy
        • IFX group: clinical remission with IFX discontinuation
      • Clinical remission rates: No change in CD-related therapy or need for additional resection in either group
    • Exploratory analysis: Flexible parametric survival models to assess for age-dependent effect modification of ICR vs IFX on 10-year clinical remission rates.

Assessments

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Results:

CD, Crohn’s disease; ICR, ileocaecal resection; IFX, infliximab; CI, confidence interval; IQR, interquartile range.

Haanappel A et al. ECCO 26; (Abstract citation ID: jjaf231.043, DOP006).

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ICR Group: 35.8% �(95% CI 25.6–50.1)

IFX group: 13.2% �(95% CI 6.1–23.1)

Individuals undergoing ileocaecal resection (ICR) were 3 times more likely to achieve therapy-free remission compared with those treated with infliximab (IFX) at 10 years.

Difference: 22.6% (95% CI 7.8–36.8); p=0.004

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Baseline characteristics

ICR (n=69)

IFX (n=65)

Female

44 (64%)

46 (71%)

Age at randomization (yrs)

28 (23-41)

27 (22-38)

Disease duration (months)

12 (5-34)

14 (6-34)

Active smoking

22 (32%)

36 (48%)

Immunomodulator use

26 (38%)

36 (55%)

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Results:

  • 10-year clinical remission rates were similar between ICR and IFX groups
  • Interaction analyses suggested greater benefit with ICR in younger patients (pinteractionsss=0.020)
  • Model-estimated 10-year clinical remission rates for younger patients:
    • Age 20: 54% (ICR) vs 24% (IFX) → �difference 30% (7 to 53)
    • Age 30: 38% (ICR) vs 28% (IFX) → �difference 10% (−6 to 26)

CD, Crohn’s disease; ICR, ileocaecal resection; IFX, infliximab; HR, hazard ratio; CI, confidence interval; IQR, interquartile range.

Haanappel A et al. ECCO 26; (Abstract citation ID: jjaf231.043, DOP006).

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ICR: 36.5% vs IFX: 28.4%

p=0.27

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Conclusions

    • A significantly greater proportion of patients who had undergone ileocaecal resection (ICR) for uncomplicated ileal Crohn’s disease were in therapy-free remission at 10 years versus those who had received infliximab.
    • Younger patients derived greater benefit of sustained clinical remission following ICR (absence of change in CD-related therapy or need for repeat resection) than older patients.

Significance to clinical practice

    • Limited ileocecal resection could be considered in individuals with ileocecal disease failing conventional therapy as an alternative to advanced medical therapy.
    • The decision for surgical therapy should integrate risk factors for post operative recurrence, including patient age.

Haanappel A et al. ECCO 26; (Abstract citation ID: jjaf231.043, DOP006).

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