November 26, 2019
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Complete endoscopic healing linked with better Crohn’s outcomes

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Patients with Crohn’s disease who achieved complete mucosal healing experienced better outcomes than those who just had partial healing, according to study results.

Mathurin Fumery, MD, PhD, of Amiens University Hospital in France, and colleagues wrote that mucosal healing is considered a crucial therapeutic target in CD and has been explored in numerous studies.

“However, the optimal cutoff to change the course of CD is yet to be determined,” they wrote. “We therefore conducted a large retrospective multicenter study to investigate the long-term impact of complete endoscopic healing vs. partial endoscopic healing on the outcome of CD patients treated with biologics.”

Researchers performed a retrospective study comprising 84 patients with CD and mucosal healing who received a biologic therapy from 2008 to 2015. They compared outcomes of patients with CD endoscopic index scores (CDEIS) of 0 (complete healing) with CDEIS scores greater than 0 but less than 4 (partial healing). They defined the primary outcome of treatment failure as the need for biologic optimization, initiation of corticosteroids or a Harvey-Bradshaw score above 4 associated with change in treatment, disease-related hospitalizations or intestinal resection.

Over a median follow-up of 4.8 years, 27 patients experienced treatment failure (32%) and 3 underwent intestinal resection (3.6%). Treatment failure among patients with complete mucosal healing was 25%, while among patients with partial healing it was 48% (P = .045).

Compared with complete healing, patients with partial healing had shorter median time to treatment failure (21 months vs. 13 months) and higher rates of CD-related hospitalization (3.5% vs. 18%). Additionally, no patients with complete healing underwent resection.

Fumery and colleagues determined that having a CDEIS score greater than 0 but less than 4 was the only factor associated with treatment failure (HR = 2.6; 95% CI, 1.2–5.8).

“Similar to ulcerative colitis, a deeper endoscopic healing may be required to change disease course in CD,” they wrote. “Before systematically implementing these new findings in our clinical practice, this needs to be investigated in prospective ‘treat-to-target’ intervention trials comparing different targets for mucosal healing in CD.” – by Alex Young

Disclosures: Fumery reports receiving lecture and consultant fees from AbbVie, Boehringer, Ferring, Janssen, MSD, Pfizer and Takeda. Please see the full study for all other authors’ relevant financial disclosures.