Issue 20

Clinical Question

Does deep remission in early Crohn’s disease lead to better outcomes?

Editor’s Bottom Line

Patients with newly-diagnosed Crohn’s disease who enter deep remission have a more favourable disease course. This adds to literature that favours endoscopy-based treat-to-target strategies.

Reference

Ungaro RC, Yzet C, Bossuyt P, et al. Deep Remission at 1 Year Prevents Progression of Early Crohn’s Disease. Gastroenterol. 2020;159(1):139–47; https://doi.org/10.1053/j.gastro.2020.03.039

Synopsis

To determine the impact of deep, endoscopic and clinical remission in patients with early Crohn’s disease (CD), researchers analyzed data from 122 individuals who had moderate-to-severe CD. Patients had participated in the multicenter CALM study, in which half of the study population was randomly assigned to have adalimumab-based treatment guided by levels of fecal calprotectin and serum C-reactive protein as well as symptoms, or to undergo conventional treatment management. The median disease duration prior to entry into CALM was 0.2 years.

Patients had disease activity assessed at the end of the 48-week CALM study and were considered to be in deep remission at that time if they had a CD Endoscopic Index of Severity (CDEIS) score below 4 with no deep ulcerations, and no steroid treatment for at least eight weeks. The current analysis included a median follow-up of three years (Range: 0.05 to 6.26 years) after the end of the 48-week CALM study.

The authors found that 27.9% of all patients experienced disease progression during follow-up. In multivariate analyses, the risk of disease progression during follow-up was 81% lower among those who achieved deep remission by the end of the CALM study than among those who did not achieve deep remission at that time (Adjusted Hazard Ratio [aHR]: 0.19; 95% Confidence Interval [CI], 0.07–0.31; p=.01). In contrast, those who achieved endoscopic remission or clinical remission alone were 59% (aHR: 0.41; 95% CI, 0.24–0.6) and 60% (aHR: 0.4; 95% CI, 0.26–0.57) less likely, respectively, to experience disease progression during follow-up, compared to those who did not experience endoscopic remission or clinical remission alone during follow-up (p<0.05 for both).

Details