Deep remission in early Crohn’s disease cuts risk of progression

Inducing deep remission in patients with early, moderate-to-severe Crohn’s disease (CD) leads to a lower risk of progression, regardless of management strategy, according to a study.

The analysis involved 122 patients (mean age, 31.2 years) with moderate-to-severe CD (median duration, 0.2 years) who participated in the effect of tight control management on CD (CALM) study. Of these patients, 61 were assigned to a tight control strategy (increased therapy based on faecal level of calprotectin, serum level of C-reactive protein, and symptoms) and the other half were assigned to conventional management.

Researchers examined the association of deep remission with the primary endpoint, which was a composite of major adverse outcomes indicating CD progression during the follow-up period (median, 3.02 years), as follows: new internal fistulas or abscesses, strictures, perianal fistulas or abscesses, or hospitalization or surgery for CD. Deep remission was defined as CD endoscopic index of severity scores <4, with no deep ulcerations or steroid treatment, for ≥8 weeks.

Over a median follow-up of 3.02 years, major adverse outcomes occurred in 34 patients (27.9 percent) during the follow-up period. Significantly fewer patients who did vs did not achieve deep remission at the end of the CALM study had the said outcomes (p=0.01).

Multivariable Cox regression analysis confirmed the association between deep remission and a lower risk of major adverse outcome (adjusted hazard ratio, 0.19, 95 percent confidence interval, 0.07–0.31).