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A Treat to Target Strategy Using Panenteric Capsule Endoscopy in Pediatric Patients With Crohn's Disease
Salvatore Oliva1, Marina Aloi1, Franca Viola1
1Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
Insights
Pan-enteric capsule endoscopy (PCE) effectively monitors pediatric Crohn's disease (CD) activity. A treat-to-target strategy using PCE significantly improved mucosal healing and deep remission rates in children with CD.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Inflammatory Bowel Disease
Background:
- Crohn's disease (CD) significantly impacts pediatric patients.
- Pan-enteric capsule endoscopy (PCE) is a valuable tool for assessing small intestinal and colonic CD.
- Monitoring mucosal healing and deep remission is crucial for effective CD management.
Purpose of the Study:
- To evaluate the efficacy of PCE in monitoring mucosal healing and deep remission in pediatric CD patients.
- To assess the utility of PCE in guiding a treat-to-target strategy for pediatric CD.
- To determine if PCE findings can lead to adjustments in therapy for improved patient outcomes.
Main Methods:
- A prospective study involving 46 pediatric CD patients.
- PCE, biomarker, and imaging analyses were conducted at baseline, 24, and 52 weeks.
- Mucosal healing and deep remission were defined using established criteria; treatments were adjusted based on PCE results.
Main Results:
- PCE detected inflammation in a significant proportion of patients at all timepoints.
- PCE findings led to therapy changes in 71% at baseline and 23% at 24 weeks.
- The treat-to-target strategy using PCE increased mucosal healing and deep remission rates from 21% to 58% over 52 weeks.
Conclusions:
- A treat-to-target strategy guided by PCE significantly enhances mucosal healing and deep remission in pediatric CD.
- PCE is effective for monitoring disease activity and guiding therapeutic adjustments in children with CD.
- This approach demonstrates a high success rate in achieving treatment goals for pediatric CD patients.
Background & Aims:
Pan-enteric capsule endoscopy (PCE) is effective for assessment of small intestinal and colonic Crohn's disease (CD) in pediatric patients. We aimed to determine whether PCE can be used to monitor mucosal healing and deep remission, in a treat to target strategy for pediatric patients with CD.
Methods:
We performed a prospective study of 48 children with a diagnosis of CD at a tertiary care pediatric gastroenterology unit; 46 patients were included in the final analysis. Biomarker, imaging, and PCE analyses were performed at baseline and after 24 and 52 weeks. Small bowel and colonic mucosal healing were defined by Lewis scores <135 and simple endoscopic score for CD ≤1, respectively. Clinical remission was defined as defined as a pediatric CD activity index score <10 and biomarker-based remission based on normal levels of biomarkers; deep remission was defined as a combination of clinical remission, biomarker-based remission, and mucosal healing. Treatments were adjusted based on findings from PCE (imaging was considered only for patients with negative findings from PCE). Therapies were introduced, optimized, switched, or combined at the discretion of treating clinicians. The primary outcome was the ability of PCE to assess mucosal healing and deep remission at 3 timepoints and to guide a treat to target strategy.
Results:
PCE detected inflammation in 34 patients (71%) at baseline, 22 patients (46%) at week 24, and 18 patients (39%) at week 52 (P for comparison among timepoints <.05). Findings from PCE led to a change in therapy for 34 patients (71%) at baseline and 11 patients (23%) at 24 weeks, whereas only 2 patients with negative results from PCE (4%) changed therapies based on findings from imaging. When the treat to target strategy was applied, proportions of patients with mucosal healing and deep remission increased from 21% at baseline, to 54% at week 24, to 58% at week 52 (P for comparison among timepoints <.05); 2 patients (4%) did not respond to treatment.
Conclusion:
In a prospective study of 48 children with CD, we found a treat to target strategy, based on findings from PCE, to significantly increase the proportions of patients with mucosal healing and deep remission.
Clinical Trial:
gov no: NCT03161886.