By Megan Brooks
NEW YORK (Reuters Health) - 29/5/2019
Patients with early Crohn's disease who achieve endoscopic or deep remission after one year of intensive treatment are less likely to experience disease progression over the next several years, new research shows.
Long-term data from the CALM trial show that "getting people with Crohn's disease into remission early on in their disease course, within the first year on average, alters the long-term outcome," Dr. Ryan Ungaro of the Icahn School of Medicine at Mount Sinai, in New York City, told Reuters Health by phone.
Dr. Ungaro presented the study May 18 in San Diego during Digestive Disease Week 2019.
Current management strategies for Crohn's disease emphasize the importance of using effective therapies earlier in the disease course (early intervention) and incorporating objective measures of inflammation, specifically endoscopy, as therapeutic goals (treat to target) to help decrease disease progression with complications such as strictures, fistulae and surgeries. However, until now, there was limited data on the long-term impact of achieving remission in early Crohn's disease patients.
Dr. Ungaro and colleagues analyzed the long-term impact of achieving endoscopic and deep remission in 122 patients with very early Crohn's disease (median disease duration 0.2 years) from the CALM trial. All of them had early intervention with an anti-TNF drug (adalimumab) and half of them were assigned to tight control and half were more conventionally managed just by symptoms.
"In the tight-control arm, treatment was escalated very rapidly based on not just symptoms but also if C-reactive protein and fecal calprotectin were elevated," Dr. Ungaro explained.
Results showed that patients with endoscopic or deep remission (endoscopic healing, plus no symptoms and no steroids) at the end of the CALM trial were significantly less likely to have a major adverse event over time.
After adjusting for age, disease duration, prior surgery, prior stricture and randomization arm, endoscopic healing or deep remission at one year was associated with a 56% and 75% decreased risk of having any complication over the next 3+ years, respectively.
"This means that achieving endoscopic healing or deep remission early in the disease course can dramatically change the course of the patient's disease over the long term," Dr. Ungaro told Reuters Health.
"Disease progression was a composite of all the adverse outcomes you would consider to be poor outcomes for Crohn's disease: a combination of surgery, hospitalization and new complications like strictures and fistula development. Getting into remission early in the disease is strongly protective against poor long term outcomes," he noted.
The findings, he added, "call for earlier endoscopic assessment for these patients, within the first year of disease as they are being treated. There is still a big gap in patients getting to the target of endoscopic healing at one year."
Digestive Disease Week 2019.