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Targeting mucosal healing in IBD linked to better long-term outcomes

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ORLANDO — Two meta-analyses presented at the 2015 Advances in IBD meeting showed both Crohn’s disease and ulcerative colitis patients who achieved early mucosal healing had better long-term outcomes, leading researchers to conclude that mucosal healing should be a treatment target.

“The paradigm in IBD is shifting away from treating to symptomatic improvement alone toward treating to more objective measures, such as mucosal healing, in addition to symptoms. However, it is unclear whether achieving mucosal healing is associated with sustained benefit as there are no prospective studies looking at mucosal healing directly and long-term outcomes,” Shailja C. Shah, MD, from The Mount Sinai Hospital in New York, told Healio Gastroenterology. “We therefore performed a systematic review and meta-analysis of studies comparing outcomes at at least 1 year in patients with active UC or Crohn’s disease who achieve mucosal healing compared to those who do not.”

Shailja C. Shah

The first meta-analysis included 12 high-quality studies involving 673 patients with active Crohn’s disease, and the second included 14 high-quality studies involving 2,019 patients with clinically and endoscopically active UC. Long-term clinical remission served as the primary endpoint for both meta-analyses.

They found that early mucosal healing was associated with a higher likelihood of achieving long-term clinical remission in both Crohn’s patients (OR = 2.8; 95% CI, 1.91-4.1) and UC patients (OR = 4.88; 95% CI, 2.54-9.37).

Crohn’s patients who achieved early mucosal healing also had a higher disease-related surgery-free rate (OR = 2.22; 95% CI, 0.86-5.69) and greater likelihood of achieving long-term mucosal healing (OR = 14.3; 95% CI, 5.57-36.74). Complete mucosal healing was found to be associated with an even higher likelihood of long-term clinical remission and mucosal healing in Crohn’s patients.

UC patients who achieved early mucosal healing also had a higher long-term colectomy-free rate (OR = 5.34; 95% CI, 2.92-9.76), a greater likelihood of achieving long-term mucosal healing (OR = 8.4; 95% CI, 3.13-22.53) and a higher corticosteroid-free clinical remission rate (OR = 9.7; 95% CI, 0.94-99.67).

Whether patients achieved mucosal healing with biologics or non-biologics did not appear to affect outcomes, according to sensitivity analyses in both studies.

“In both UC and Crohn’s disease, we found that patients who achieved mucosal healing had improved long-term outcomes including clinical remission, sustained mucosal healing, colectomy-free interval (UC), and Crohn’s disease-related surgery-free interval,” Shah said. “Based on our findings and in the absence of published prospective studies, targeting mucosal healing (in addition to symptom improvement) seems a reasonable goal of IBD therapy.” – by Adam Leitenberger 

Reference: Shah S, et al. Abstracts P-016, P-017. Presented at: Advances in Inflammatory Bowel Diseases; Dec. 10-12, 2015; Orlando, Fla.

Disclosure: The researchers report no relevant financial disclosures.