Delayed Remission With Advanced Therapies Is Not Associated With Worse 1-Year Outcomes in Inflammatory Bowel Disease

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Early response to biologic therapy in Crohn's disease (CD) and ulcerative colitis (UC) correlates with better long-term outcomes.
• A subset of patients may experience delayed remission, termed 'late remitters'.
• The characteristics and long-term prognosis of late remitters have not been extensively studied.

Purpose of the Study:

• To determine the frequency of late remission in patients with CD and UC initiating new biologic or small molecule therapies.
• To identify predictors of delayed remission.
• To evaluate the one-year clinical and endoscopic outcomes of late remitters compared to early responders and non-remitters.

Main Methods:

• Prospective single-center study of 596 patients with moderate-to-severe CD or UC.
• Patients initiated anti-TNF, vedolizumab, anti-IL, or JAK inhibitor therapy.
• Disease activity assessed using Harvey Bradshaw Index (CD) and Simple Clinical Colitis Activity Index (UC) for one year.
• Early remission defined as remission by week 14; late remission by week 30.

Main Results:

• 37% achieved remission by week 14; an additional 14% were late remitters (remission by week 30).
• Late remitters had similar one-year clinical (64% vs. 63%) and endoscopic remission (43% vs. 49%) rates compared to early remitters.
• Late remitters showed significantly better outcomes than non-remitters (13-16% remission rates).

Conclusions:

• About one-sixth of patients achieve delayed remission within 30 weeks of initiating therapy.
• These patients experience comparable long-term outcomes to those with early remission.
• Identifying predictors of delayed remission may help optimize treatment strategies and prevent premature discontinuation of effective therapies.