Original article
Alimentary tract
Endoscopic Assessment and Treating to Target Increase the Likelihood of Mucosal Healing in Patients With Crohn’s Disease

https://doi.org/10.1016/j.cgh.2013.11.005Get rights and content

Background & Aims

Mucosal healing has been proposed as a goal for treatment because it is associated with improved clinical outcomes of patients with Crohn’s disease (CD). However, little is known about the feasibility or probability of achieving mucosal healing in clinical practice. We evaluated the feasibility of treating patients to achieve mucosal healing based on endoscopic evaluation (treating to target).

Methods

We reviewed the endoscopic outcomes of 67 patients with CD who had lesions detected by endoscopy. Patients underwent 2 to 4 subsequent endoscopic evaluations at the University of California San Diego and were followed up from 2011 through 2012; data were collected on therapies and patient management. The cumulative incidences of mucosal healing and endoscopic improvement were estimated using the Kaplan–Meier method. Factors independently associated with mucosal healing were identified using a Cox proportional hazards model.

Results

After a median follow-up period of 62 weeks, 34 patients (50.7%) had mucosal healing and 41 patients (61.1%) had endoscopic improvement. The cumulative probabilities of mucosal healing were 12.7% and 45.0% at 24 and 52 weeks of treatment, respectively. Factors associated with mucosal healing were as follows: fewer than 26 weeks between endoscopic procedures (hazard ratio, 2.35; 95% confidence interval, 1.15–4.97; P = .035) and adjustment to medical therapy when mucosal healing was not observed (hazard ratio, 4.28; 95% confidence interval, 1.9–11.5; P = .0003).

Conclusions

In an endoscopic study of patients with CD, we found that assessment of endoscopic disease activity and adjustments to medical therapy (treat to target) increase the likelihood of mucosal healing.

Section snippets

Study Population

All medical records of consecutive patients referred to the Inflammatory Bowel Disease (IBD) center at the University of California San Diego (UCSD) between January 2011 and December 2012 were reviewed. The International Classification of Diseases, 9th revision, codes were used to identify all patients with a diagnosis of CD or regional enteritis who were referred to UCSD. The diagnosis of CD then was confirmed based on radiologic, endoscopic, and/or histologic evidence. Only patients with CD

Characteristics of the Population at Referral

Of 510 patients with CD seen at UCSD during the study period, 199 patients were referred to the IBD center, leading to 171 endoscopic procedures performed at the time of referral. A total of 110 patients had at least 2 consecutive endoscopic procedures performed during the study period. Among those 110 patients, 67 patients who had ulcers seen at the initial endoscopic procedure constituted the study population.

The baseline characteristics of these 67 patients are listed in Table 1. Of these

Discussion

This study specifically investigated the feasibility of a treat-to-target approach in patients with CD, in which the goal of medical therapy is endoscopic healing of the mucosa. In this retrospective cohort of patients with moderate to severe CD, we found that a high rate of MH can be achieved. The occurrence of MH during the study period was associated strongly with adjustment in medical therapy according to endoscopic findings.

MH is receiving increasing attention based on observations that

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  • Cited by (0)

    Conflicts of interest These authors disclose the following: Guillaume Bouguen has received lecture fees from Abbott Laboratories, Ferring, and MSD Pharma. Barrett G. Levesque is a consultant for Santarus Inc, Prometheus Laboratories, and Castlight Health; and is a member of the speakers bureau for Warner Chilcott, UCB Pharma, Abbott Labs, and Salix. William Sandborn has received consulting fees from ActoGeniX NV, AGI Therapeutics, Inc, Alba Therapeutics Corporation, Albireo, Alfa Wasserman, Amgen, AM-Pharma BV, Anaphore, Astellas Pharma, Athersys, Inc, Atlantic Healthcare Limited, Axcan Pharma (now Aptalis), BioBalance Corporation, Boehringer-Ingelheim, Inc, Bristol Meyers Squibb, Celgene, Celek Pharmaceuticals, Cellerix SL, Cerimon Pharmaceuticals, ChemoCentryx, CoMentis, Cosmo Technologies, Coronado Biosciences, Cytokine Pharmasciences, Eagle Pharmaceuticals, Eisai Medical Research, Inc, Elan Pharmaceuticals, EnGene, Inc, Eli Lilly, Enteromedics, Exagen Diagnostics, Inc, Ferring Pharmaceuticals, Flexion Therapeutics, Inc, Funxional Therapeutics Limited, Genzyme Corporation, Genentech (now Roche), Gilead Sciences, Given Imaging, Glaxo Smith Kline, Human Genome Sciences, Ironwood Pharmaceuticals (previously Microbia, Inc), Janssen (previously Centocor), KaloBios Pharmaceuticals, Inc, Lexicon Pharmaceuticals, Lycera Corporation, Meda Pharmaceuticals (previously Alaven Pharmaceuticals), Merck Research Laboratories, MerckSerono, Millennium Pharmaceuticals (subsequently merged with Takeda), Nisshin Kyorin Pharmaceuticals Co, Ltd, Novo Nordisk A/S, NPS Pharmaceuticals, Optimer Pharmaceuticals, Orexigen Therapeutics, Inc, PDL Biopharma, Pfizer, Procter and Gamble, Prometheus Laboratories, ProtAb Limited, Purgenesis Technologies, Inc, Receptos, Relypsa, Inc, Salient Pharmaceuticals, Salix Pharmaceuticals, Inc, Santarus, Schering Plough Corporation (acquired by Merck), Shire Pharmaceuticals, Sigmoid Pharma Limited, Sirtris Pharmaceuticals, Inc (a Glaxo Smith Kline company), S.L.A. Pharma (UK) Limited, Targacept, Teva Pharmaceuticals, Therakos, Tillotts Pharma AG (acquired by Zeria Pharmaceutical Co, Ltd), TxCell SA, UCB Pharma, Viamet Pharmaceuticals, Vascular Biogenics Limited (VBL), Warner Chilcott UK Limited, Wyeth (now Pfizer); has received lecture fees from Bristol Meyers Squibb and Janssen (previously Centocor); and has received research support from Bristol Meyers Squibb, Genentech, Glaxo Smith Kline, Janssen (previously Centocor), Millennium Pharmaceuticals (now Takeda), Novartis, Pfizer, Procter and Gamble Pharmaceuticals, Shire Pharmaceuticals, and UCB Pharma. The remaining authors disclose no conflicts.

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