28 Mar Crohn’s Disease: Early Deep Remission Blocks Further Progression

MedicalResearch.com Interview with:

Dr. Colombel

Jean-Frederic Colombel MD
The Henry D Janowitz Division of Gastroenterology
Icahn School of Medicine at Mount Sina
New York, NY 10029, USA

MedicalResearch.com: What is the background for this study?

Response: The goals of therapy in Crohn’s disease have shifted from mere control of symptoms also called clinical remission towards combination of clinical and endoscopic remission also called deep remission which is now considered as the new therapeutic “target”. However it has yet to be proven that targeting deep remission instead of clinical remission is able to stop the progression of Crohn’s disease towards bowel damage, complications and hospitalizations.

This study is a post-hoc analysis of the CALM trial that was published in The Lancet in 2018 where newly diagnosed patients were randomized to escalate therapy based on symptoms only (control arm) or based on a combination of symptoms and two biomarkers namely C-reactive protein in blood and calprotectin in stools (tight control arm).

MedicalResearch.com: What are the main findings? 

Response: The main conclusion of that study was that more patients in the tight control arm were able to reach the endpoints of clinical remission alone, endoscopic remission alone and combination (deep remission) than in the control arm at one year.

In the present study we were able to get follow-up data on approximately 50% of the original cohort up to 3 years after completion of the study. The main finding was that patients who were in deep remission at one year had the best long term outcomes with significantly less complications, hospitalizations and surgeries than those who did not achieve this endpoint at the end of the original CALM study. Acknowledging the limitations (post-hoc analysis, no follow-up data available for all patients) this is first demonstration that the treat to target (deep remission) strategy is able to block progression of Crohn’s disease. 

MedicalResearch.com: What should readers take away from your report?

Response: By applying the three pillars of care which are early intervention, tight control and treat to target Crohn’s disease can be controlled and its progression blocked.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: This data need to be validated in a prospective study which is actually ongoing and is called REACT 2 where patients are randomized between achieving clinical remission or deep remission and followed up for evidence of disease progression. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The biggest challenge in the future would be to know if at some point therapy can be stopped in patients in deep remission which would mean cure (no disease, no treatment). I am not optimistic about that though we have ongoing studies about possible de-escalation strategies. This is why at Mount Sinai we are investing a lot of research efforts in catching the disease in its pre-clinical phase in order to prevent its onset. This is the topic of other papers that we just published as well.

No disclosure.

The original study (CALM) was a study initiated by Abbvie but the follow-up which is here presented was an independent study.

Citation:

Deep Remission at 1 Year Prevents Progression of Early Crohn’s Disease
Ungaro, Ryan C. et al.
Gastroenterology, Volume 0, Issue 0 

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Last Updated on March 28, 2020 by Marie Benz MD FAAD