Crohn’s disease is characterized by deep, transmural inflammation, making structural healing an essential therapeutic objective. According to STRIDE-II treatment targets for Crohn’s disease, achieving objective measures of improvement—including endoscopic response as a key indicator of transmural healing—is essential for long-term disease control. Risankizumab (RISA), an interleukin-23 p19 inhibitor, demonstrated significant endoscopic benefits in clinical trials; however, its real-world performance regarding endoscopic improvement requires further evaluation. The aim of this study is to systematically assess real-world endoscopic outcomes associated with RISA therapy in patients with moderately to severely active Crohn’s disease.

A systematic review and meta-analysis of real-world studies reporting endoscopic outcomes following RISA treatment was performed. Pooled rates of endoscopic response and endoscopic remission were calculated using a random-effects model with 95% confidence intervals.

Across included real-world studies, the pooled endoscopic response rate was 69% at 24 weeks and 58% at 52 weeks. Endoscopic remission at 52 weeks was achieved in 52% of patients.

Real-world evidence demonstrates that RISA produces substantial and durable endoscopic improvement, supporting its role as a long-term therapeutic option that contributes meaningfully to the pursuit of transmural healing in Crohn’s disease.