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Mucosal healing strongly associated with positive clinical outcomes in IBD
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In patients with inflammatory bowel disease, endoscopic mucosal healing is a significant predictor of favorable clinical outcomes, including fewer surgeries and hospitalizations and long-term clinical remission, according to the results of a meta-analysis.
“As ulcerative colitis (UC) and luminal Crohn’s disease (CD) are primarily diseases of mucosal inflammation and ulceration, endoscopic mucosal healing (MH) has risen to prominence as a key surrogate end point,” researchers from University of Michigan, Ann Arbor, wrote. “With the inclusion of MH as a trial end point, we now have the opportunity to evaluate the effect of MH on subsequent clinical outcomes. Additionally, we may be able to answer the question of how much MH is required to achieve certain treatment goals.”
The researchers reviewed all published cohort studies and randomized controlled trials that evaluated interval MH throughout IBD treatment, followed healed and unhealed patients, and recorded data on surgeries, hospitalizations and clinical remission. They ultimately included 19 studies in their analysis (n = 2,256) and performed weighted random-effects meta-analysis to determine the relative risks for each outcome of interest.
Pooled analyses of patients with UC and CD showed that, compared with no healing, MH predicted fewer major abdominal surgeries (RR = 0.34; 95% CI, 0.26-0.46), fewer hospitalizations (RR = 0.58; 95% CI, 0.42-0.78), and increased remission (RR = 1.84; 95% CI, 1.43-2.36). When analyzing CD and UC patients separately, MH also predicted fewer surgeries and increased remission, but there were insufficient data to compare hospitalizations between CD and UC patients.
Both complete and partial MH predicted significantly higher rates of these outcomes compared with no healing. Comparing complete vs. partial MH after excluding patients with no healing showed a nonsignificant difference in surgery risk, whereas complete MH was superior in predicting corticosteroid-free remission (RR = 1.71; 95% CI, 1.24-2.34). Meta-regression showed the predictive ability of complete vs. partial MH for remission was strongly related to follow-up duration.
“Our analysis demonstrates that in both CD and UC, across multiple medication regimens, endoscopic MH is strongly associated with lower rates of subsequent major surgeries, hospitalizations, and active disease,” the researchers concluded. “This provides the best evidence to date for the prognostic benefit of MH.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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