Objective evaluation for treat to target in Crohn’s disease

Takenaka, Katsuto; Kitazume, Yoshio; Fujii, Toshimitsu; Tsuchiya, Kiichiro; Watanabe, Mamoru; Ohtsuka, Kazuo

doi:10.1007/s00535-020-01678-8

Cited by 18 publications

(17 citation statements)

References 117 publications

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“…Consequently, the treatment endpoint has also kept evolving. 24 MH has long been considered the gold-standard treatment endpoint, but its limitations are obvious as well, including the inability to indicate the transmural pathological features of CD, poor access to the small intestine, and contraindication for patients with stenosis or perforation. In a meta-analysis by Reinink et al ., 8 MH predicted lower rates of surgeries and hospitalizations and higher rates of CR, but relative-risk values were just within 0.34–1.84.…”

Section: Discussionmentioning

confidence: 99%

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn’s disease

Zhuang

et al. 2021

Therap Adv Gastroenterol

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Background: Transmural healing (TH) is being increasingly recognized for reflecting deep remission in Crohn’s disease (CD). The long-term clinical significance of achieving TH is still not fully known. We aimed to evaluate TH as a predictor of long-term positive outcomes using intestinal ultrasonography (US), with comparison with the established endpoint mucosal healing (MH). Methods: CD patients were consecutively recruited from September 2015 to August 2018 at a single tertiary hospital. All patients were evaluated at baseline and followed up at 6 months prospectively with a guideline-based treatment regimen. Achieving TH/MH or not was evaluated by US/colonoscopy at the first follow-up. Long-term outcomes including steroid-free clinical remission (CR), drug escalation, hospitalization, and surgery, were recorded after at least another 12 months. Results: We identified 77 patients with a median age of 30 years (range, 12–73 years). Twenty-five (32%) patients achieved TH, and 31 (40%) patients achieved MH. TH and MH were poorly correlated (Cohen’s κ = 0.387; p < 0.05). Univariate analysis showed that both MH and TH were associated with better long-term outcomes. In multivariate analysis, TH was an independent predictor of steroid-free CR [odds ratio (OR), 52.6; p < 0.001], drug escalation (OR, 0.1; p = 0.002), and hospitalization (OR, 0.05; p = 0.005), while MH was an independent predictor of drug escalation (OR, 0.3; p = 0.05). Smoking habit was the only predictor of surgery (OR, 6.6; p = 0.02). Conclusion: TH is an independent predictor of more favorable long-term outcomes than MH, suggesting that TH could become the potential treatment endpoint in CD. Plain language summary Transmural healing predicts good prognosis in Crohn’s disease The therapeutic endpoints of Crohn’s disease keep evolving. The long-term clinical significance of achieving transmural healing is not fully discovered. Transmural healing is an independent predictor of more favorable long-term outcomes than mucosal healing. Transmural healing could become the potential treatment endpoint in Crohn’s disease.

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Section: Discussionmentioning

confidence: 99%

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn’s disease

Zhuang

et al. 2021

Therap Adv Gastroenterol

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“…However, the same is not true for established CD. A major concern that may have been causing apprehension for this indication is the possible higher risk of capsule retention in the later set of patients [18]. Nonetheless, it is now becoming clear that SBCE is a safe method to assess endoscopic activity in established small-bowel CD.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding potential predictors of increased risk of disease relapse, the infliximab discontinuation in Crohn's disease patients in stable remission on combined therapy with immunosuppressors (STORI) trial was one of the first prospective studies that carried a follow-up of patients with CD remission [29]. The authors projected to identify possible risk factors to have a disease relapse during the follow-up period, what would be useful upon selecting those patients having a low risk of relapsing when stepping-down treatment.…”

Section: Discussionmentioning

confidence: 99%

Apex Score: Predicting Flares in Small-Bowel Crohn’s Disease After Mucosal Healing

et al. 2021

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Background Optimal strategies for using small-bowel capsule endoscopy (SBCE) in established small-bowel Crohn's disease (CD) remain uncertain. Mucosal healing (MH) has emerged as a valuable predictor of a flare-free disease. We aimed to evaluate the occurrence of disease flare on patients with small-bowel CD and MH, as well as to create a score identifying patients in higher risk for this outcome. Methods We analyzed consecutive patients submitted to SBCE for assessment of MH and included those where MH was confirmed. The incidence of disease flare was assessed during follow-up (minimum 12 months). A score predicting disease flare was created from several analyzed variables. Results From 47 patients with MH, 12 (25.5%) had a flare (versus 48.3% in excluded patients without MH; p = 0.01). Age ≤ 30 years (OR = 70; p = 0.048), platelet count ≥ 280 × 10 3 /L (OR = 12.24; p = 0.045) and extra-intestinal manifestations (OR = 11.76; p = 0.033) were associated with increased risk of CD flare during the first year after SBCE with MH. These variables were used to compute a risk-predicting score-the APEX score-which assigned the patients to having low (0-3 points) or high-risk (4-7 points) of disease flare and had excellent accuracy toward predicting disease relapse (AUC = 0.82; 95%CI 0.64-0.99). Conclusion Patients with small-bowel CD and MH were not free of disease flares on the subsequent year, despite presenting lower rates when compared to those without MH. The APEX score demonstrated excellent accuracy at stratifying patients relapse risk and guiding further therapeutic options for patients achieving MH.

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“…Other complications that can be observed in patients are strictures, fistulas, and abscesses. The pathophysiology of CD is also not wholly elucidated, but microbial exposure, genetic, and environmental factors may be associated [27,28]. Figure 2 shows some pathophysiologic aspects of UC and CD.…”

Section: Inflammatory Bowel Diseasesmentioning

confidence: 99%

Cannabis and Canabidinoids on the Inflammatory Bowel Diseases: Going Beyond Misuse

Carvalho

Souza

Marqui

et al. 2020

IJMS

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Inflammatory bowel diseases (IBD) are characterized by a chronic and recurrent gastrointestinal condition, including mainly ulcerative colitis (UC) and Crohn’s disease (CD). Cannabis sativa (CS) is widely used for medicinal, recreational, and religious purposes. The most studied compound of CS is tetrahydrocannabinol (THC) and cannabidiol (CBD). Besides many relevant therapeutic roles such as anti-inflammatory and antioxidant properties, there is still much controversy about the consumption of this plant since the misuse can lead to serious health problems. Because of these reasons, the aim of this review is to investigate the effects of CS on the treatment of UC and CD. The literature search was performed in PubMed/Medline, PMC, EMBASE, and Cochrane databases. The use of CS leads to the improvement of UC and CD scores and quality of life. The medical use of CS is on the rise. Although the literature shows relevant antioxidant and anti-inflammatory effects that could improve UC and CD scores, it is still not possible to establish a treatment criterion since the studies have no standardization regarding the variety and part of the plant that is used, route of administration and doses. Therefore, we suggest caution in the use of CS in the therapeutic approach of IBD until clinical trials with standardization and a relevant number of patients are performed.

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Objective evaluation for treat to target in Crohn’s disease

Cited by 18 publications

References 117 publications

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn’s disease

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn’s disease

Apex Score: Predicting Flares in Small-Bowel Crohn’s Disease After Mucosal Healing

Cannabis and Canabidinoids on the Inflammatory Bowel Diseases: Going Beyond Misuse

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