Induction of deep remission at 1 year in early, biologic naive Crohn’s disease protects against disease progression regardless of tight disease control or conventional management
Pal P, MD,MRCP, reviewing Ungaro RC et al in Gastroenterology July 2020
In a retrospective study of patients who participated in CALM trial ( a phase III randomized controlled study published in 2017) which showed that timely escalation of therapy with anti-TNF (adalimumab) based on clinical symptoms and biomarkers (Fecal calprotectin and CRP) in early Crohn’s disease patients (disease duration median 0.2 yr, IQR- 0.1-0.5) results in better mucosal healing at 48 weeks compared to therapy based on symptoms alone. 50% patients of the CALM study were followed up over 3 years and time to event analysis showed that the patients who achieved deep remission at 48 weeks (defined as endoscopic and clinical remission and no steroid requirement for last 8 weeks) during the CALM study had significant lower risk of disease associated complications (stricture, fistula, surgery, hospitalization) over next 3 years (irrespective of tight control based on symptoms and biomarkers or conventional management based on symptoms alone).
This study is important in the context of the developing world where IBD is on the rise as early diagnosis and induction of deep remission
in CD in the first year of disease can prevent future disease associated complications.
Ungaro RC, Yzet C, Bossuyt P, et al. Deep Remission at 1 Year Prevents Progression of Early Crohn's Disease. Gastroenterology. 2020;159(1):139-147. doi:10.1053/j.gastro.2020.03.039