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Intensive Treatment Within the First Year Prevents Early Crohn’s Progression
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Patients with early Crohn’s disease who can achieve endoscopic or deep remission after one year of treatment are less likely to experience disease progression, according to data from the CALM trial presented at the Congress of the European Crohn’s and Colitis Organisation.
Clara Yzet, MD, from Amiens University Hospital in France, said that in the CALM trial, patients with early diagnosed CD were put into two groups. In the clinical management group, patients received dose escalation based on clinical symptoms, while patients in a tight control group had step-up therapy based on clinical symptoms, as well as inflammatory biomarkers such as fecal calprotectin and C-reactive protein.
“It is known that [CD], over time, leads to the accumulation of bowel damage, such as strictures, fistula and abscess that often require surgery,” she said in her presentation. “The question now is, does a tight control strategy early in the disease course, such as in the CALM trial, change the natural history of [CD] with the goal of decreasing hospitalization, surgery and bowel damage over the long term?”
Researchers analyzed data from 122 patients who were assigned to the tight control arm of the CALM study. They stratified patients based on outcomes at one year, including clinical remission, endoscopic remission and deep remission, and assessed a composite of major adverse outcomes (new fistula/abscess, stricture, perianal fistula/abscess, CD hospitalization or CD surgery) reflecting CD progression.
Thirty-four patients (27.9%) experienced a major adverse outcome during a median follow-up of 3.02 years.
After adjusting for age, disease duration, prior surgery, prior stricture and randomization arm, Yzet and colleagues found that endoscopic remission (adjusted HR = 0.44; 95% CI, 0.2–0.96) and deep remission (aHR = 0.25; 95% CI, 0.09–0.72) were both significantly associated with a lower risk for major adverse events.
Patients who were in clinical remission at one year did not have significantly lower rates of major adverse events.
“This study shows that reaching the targets of endoscopic and deep remission early in the disease course can result in long-term disease modification in [CD],” Yzet concluded. – by Alex Young
Reference:
Yzet C, et al. Abstract OP35. Presented at: Congress of the European Crohn’s and Colitis Organisation; Mar. 7-9, 2019; Copenhagen.
Disclosure: Yzet reports no relevant financial disclosures. Please see the ECCO disclosure database for all other authors’ relevant financial disclosures.