Achieving Deep Remission Early, No Matter How, Is Best Way to Decrease Crohn’s Disease Progression
Monika Fischer, MD, reviewing Ungaro RC, et al. Gastroenterology 2020 Mar 26.
The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) program recommended deep remission (endoscopic plus clinical remission) as the preferred treatment target for Crohn’s disease. There are very limited data on whether achievement of deep remission is a disease modifier.
Researchers retrospectively analyzed long-term (median=3 years) outcomes of 122 participants in the effect of tight control management on Crohn’s disease (CALM) study. Within the CALM study, patients with short disease duration (median=0.2 years) were treated with induction prednisone, tapered up to 8 weeks, then received no therapy or escalating doses of adalimumab with or without azathioprine when needed due to active disease. The patients were randomized to the tight control approach (treatment adjusted based on symptoms, C-reactive protein [CRP], or calprotectin) or the standard approach (treatment adjusted based on clinical symptoms only) to achieve deep remission.
Deep remission at 48 weeks was associated with an 81% decrease in the risk of long-term adverse outcomes, including new perianal or intrabdominal fistulas, abscesses, or strictures, or surgery or hospitalization (adjusted hazard ratio [aHR], 0.19; 95% confidence interval, 0.08-0.31). Endoscopic remission (aHR, 0.41; 0.24-0.60) and clinical remission (aHR, 0.40; 0.26-0.57) were associated with favorable outcomes but to a lesser degree after adjustments for the CALM treatment arm, age, sex, disease duration, baseline CRP, baseline calprotectin, disease location, smoking, prior surgery, and history of stricturing disease.
COMMENT
Early intervention (preferably within a few months of diagnosis) seems to be the key to preventing complications of Crohn’s disease. This study provides evidence that achieving deep remission can favorably modify disease course. The results suggest that it does not matter what type of therapy or treatment approach is applied (prednisone, biologic agent, immunomodulator; tight controlled vs standard approach) as long as the target (deep remission) is achieved.
Monika Fischer, MD, FASGE
CITATION(S )
Ungaro RC, Yzet C, Bossuyt P, et al. Deep remission at 1 year prevents progression of early Crohn’s disease. Gastroenterology 2020 Mar 26 (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2020.03.039)
