Transmural remission improves clinical outcomes up to 5 years in Crohn's disease

Introduction Evidence supporting transmural remission (TR) as a long‐term treatment target in Crohn's disease (CD) is still unavailable. Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long‐term. Met...

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Published in:United European gastroenterology journal 2023-02, Vol.11 (1), p.51-59
Main Authors: Fernandes, Samuel Raimundo, Serrazina, Juliana, Botto, Inês Ayala, Leal, Tiago, Guimarães, Andreia, Garcia, Joana Lemos, Rosa, Isadora, Prata, Rita, Carvalho, Diana, Neves, João, Campelo, Pedro, Ventura, Sofia, Silva, Andrea, Coelho, Mariana, Sequeira, Cristiana, Oliveira, Ana Paula, Portela, Francisco, Ministro, Paula, Tavares de Sousa, Helena, Ramos, Jaime, Claro, Isabel, Gonçalves, Raquel, Correia, Luís Araújo, Marinho, Rui Tato, Cortez‐Pinto, Helena, Magro, Fernando
Format: Article
Language:English
Subjects:
Clinical outcomes
Colonoscopy
Crohn Disease - diagnostic imaging
Crohn Disease - drug therapy
Crohn's disease
Demographics
Drug dosages
Endoscopy
Hospitalization
Humans
Immunomodulators
Inflammation
Inflammatory Bowel Disease
Magnetic Resonance Imaging - methods
MRI enterography
Original
Remission (Medicine)
Remission Induction
Retrospective Studies
Small intestine
Statistical analysis
Steroids
Surgery
transmural remission
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cited_by cdi_FETCH-LOGICAL-c4486-5e1e011e8645fcd2c2a392172f065284ac9580fd592dab17997a0cbee3d8e4533
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container_issue 1
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container_title United European gastroenterology journal
container_volume 11
creator Fernandes, Samuel Raimundo
Serrazina, Juliana
Botto, Inês Ayala
Leal, Tiago
Guimarães, Andreia
Garcia, Joana Lemos
Rosa, Isadora
Prata, Rita
Carvalho, Diana
Neves, João
Campelo, Pedro
Ventura, Sofia
Silva, Andrea
Coelho, Mariana
Sequeira, Cristiana
Oliveira, Ana Paula
Portela, Francisco
Ministro, Paula
Tavares de Sousa, Helena
Ramos, Jaime
Claro, Isabel
Gonçalves, Raquel
Correia, Luís Araújo
Marinho, Rui Tato
Cortez‐Pinto, Helena
Magro, Fernando
description Introduction Evidence supporting transmural remission (TR) as a long‐term treatment target in Crohn's disease (CD) is still unavailable. Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long‐term. Methods Multicenter retrospective study including 404 CD patients evaluated by magnetic resonance enterography and colonoscopy. Five‐year rates of hospitalization, surgery, use of steroids, and treatment escalation were compared between patients with TR, IER, IRR, and no remission (NR). Results 20.8% of CD patients presented TR, 23.3% IER, 13.6% IRR and 42.3% NR. TR was associated with lower risk of hospitalization (odds‐ratio [OR] 0.244 [0.111–0.538], p 
doi_str_mv 10.1002/ueg2.12356
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Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long‐term. Methods Multicenter retrospective study including 404 CD patients evaluated by magnetic resonance enterography and colonoscopy. Five‐year rates of hospitalization, surgery, use of steroids, and treatment escalation were compared between patients with TR, IER, IRR, and no remission (NR). Results 20.8% of CD patients presented TR, 23.3% IER, 13.6% IRR and 42.3% NR. TR was associated with lower risk of hospitalization (odds‐ratio [OR] 0.244 [0.111–0.538], p &lt; 0.001), surgery (OR 0.132 [0.030–0.585], p = 0.008), steroid use (OR 0.283 [0.159–0.505], p &lt; 0.001), and treatment escalation (OR 0.088 [0.044–0.176], p &lt; 0.001) compared to no NR. IRR resulted in lower risk of hospitalization (OR 0.333 [0.143–0.777], p = 0.011) and treatment escalation (OR 0.260 [0.125–0.540], p &lt; 0.001), while IER reduced the risk of steroid use (OR 0.442 [0.262–0.745], p = 0.002) and treatment escalation (OR 0.490 [0.259–0.925], p = 0.028) compared to NR. Conclusions TR improved clinical outcomes over 5 years of follow‐up in CD patients. Distinct but significant benefits were seen with IER and IRR. This suggests that both endoscopic and radiologic remission should be part of the treatment targets of CD.</description><identifier>ISSN: 2050-6406</identifier><identifier>EISSN: 2050-6414</identifier><identifier>DOI: 10.1002/ueg2.12356</identifier><identifier>PMID: 36575615</identifier><language>eng</language><publisher>England: John Wiley &amp; Sons, Inc</publisher><subject>Clinical outcomes ; Colonoscopy ; Crohn Disease - diagnostic imaging ; Crohn Disease - drug therapy ; Crohn's disease ; Demographics ; Drug dosages ; Endoscopy ; Hospitalization ; Humans ; Immunomodulators ; Inflammation ; Inflammatory Bowel Disease ; Magnetic Resonance Imaging - methods ; MRI enterography ; Original ; Remission (Medicine) ; Remission Induction ; Retrospective Studies ; Small intestine ; Statistical analysis ; Steroids ; Surgery ; transmural remission</subject><ispartof>United European gastroenterology journal, 2023-02, Vol.11 (1), p.51-59</ispartof><rights>2022 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.</rights><rights>2023. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). 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Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long‐term. Methods Multicenter retrospective study including 404 CD patients evaluated by magnetic resonance enterography and colonoscopy. Five‐year rates of hospitalization, surgery, use of steroids, and treatment escalation were compared between patients with TR, IER, IRR, and no remission (NR). Results 20.8% of CD patients presented TR, 23.3% IER, 13.6% IRR and 42.3% NR. TR was associated with lower risk of hospitalization (odds‐ratio [OR] 0.244 [0.111–0.538], p &lt; 0.001), surgery (OR 0.132 [0.030–0.585], p = 0.008), steroid use (OR 0.283 [0.159–0.505], p &lt; 0.001), and treatment escalation (OR 0.088 [0.044–0.176], p &lt; 0.001) compared to no NR. IRR resulted in lower risk of hospitalization (OR 0.333 [0.143–0.777], p = 0.011) and treatment escalation (OR 0.260 [0.125–0.540], p &lt; 0.001), while IER reduced the risk of steroid use (OR 0.442 [0.262–0.745], p = 0.002) and treatment escalation (OR 0.490 [0.259–0.925], p = 0.028) compared to NR. Conclusions TR improved clinical outcomes over 5 years of follow‐up in CD patients. Distinct but significant benefits were seen with IER and IRR. 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Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long‐term. Methods Multicenter retrospective study including 404 CD patients evaluated by magnetic resonance enterography and colonoscopy. Five‐year rates of hospitalization, surgery, use of steroids, and treatment escalation were compared between patients with TR, IER, IRR, and no remission (NR). Results 20.8% of CD patients presented TR, 23.3% IER, 13.6% IRR and 42.3% NR. TR was associated with lower risk of hospitalization (odds‐ratio [OR] 0.244 [0.111–0.538], p &lt; 0.001), surgery (OR 0.132 [0.030–0.585], p = 0.008), steroid use (OR 0.283 [0.159–0.505], p &lt; 0.001), and treatment escalation (OR 0.088 [0.044–0.176], p &lt; 0.001) compared to no NR. IRR resulted in lower risk of hospitalization (OR 0.333 [0.143–0.777], p = 0.011) and treatment escalation (OR 0.260 [0.125–0.540], p &lt; 0.001), while IER reduced the risk of steroid use (OR 0.442 [0.262–0.745], p = 0.002) and treatment escalation (OR 0.490 [0.259–0.925], p = 0.028) compared to NR. Conclusions TR improved clinical outcomes over 5 years of follow‐up in CD patients. Distinct but significant benefits were seen with IER and IRR. This suggests that both endoscopic and radiologic remission should be part of the treatment targets of CD.</abstract><cop>England</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>36575615</pmid><doi>10.1002/ueg2.12356</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6626-205X</orcidid><orcidid>https://orcid.org/0000-0003-2634-9668</orcidid><orcidid>https://orcid.org/0000-0002-2947-8791</orcidid><orcidid>https://orcid.org/0000-0002-2953-5987</orcidid><orcidid>https://orcid.org/0000-0002-0604-2290</orcidid><orcidid>https://orcid.org/0000-0002-8537-8744</orcidid><oa>free_for_read</oa></addata></record>
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subjects Clinical outcomes
Colonoscopy
Crohn Disease - diagnostic imaging
Crohn Disease - drug therapy
Crohn's disease
Demographics
Drug dosages
Endoscopy
Hospitalization
Humans
Immunomodulators
Inflammation
Inflammatory Bowel Disease
Magnetic Resonance Imaging - methods
MRI enterography
Original
Remission (Medicine)
Remission Induction
Retrospective Studies
Small intestine
Statistical analysis
Steroids
Surgery
transmural remission
title Transmural remission improves clinical outcomes up to 5 years in Crohn's disease
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