Transmural improvement may be an acceptable target in patients with Crohns disease

Transmural remission is associated with improved long-term outcomes in Crohns disease (CD) but is seldom achieved in clinical practice. Less demanding targets may present reasonable alternatives in selected patients.

Retrospective analysis including 411 CD patients with 2 evaluations using endoscopy and MRI enterography. Rates of surgery, hospitalization, steroid use, treatment change, and phenotype progression were compared between different degrees of endoscopic and radiologic improvement. Endoscopic remission and improvement were defined as a simplified endoscopic score for CD (SES-CD) ≤3 and as a decrease of ≥50% in the SES-CD, respectively. Radiologic remission and improvement were defined as a simplified Magnetic Resonance Index of Activity (sMaRIA) score ≤1 and as a decrease of ≥1 in the sMaRIA score with a ≤25% decrease in the bowel wall thickness. Regression and propensity score matching with inverse probability weighting (IPW) were used to correct for confounders.

Although inferior to transmural remission, transmural improvement provided better results than no transmural improvement in respect to surgery (0.8% vs 16.3% vs 46.8%, P < .001), hospitalization (4.1% vs 30.8% vs 55.4%, P < .001), steroid use (8.3% vs 34.6% vs 51.1%, P ≤ .01), treatment change (12.4% vs 51.9% vs 67.2%, P ≤ .012), and phenotype progression (5.9% vs 15.4% vs 31.0%, P ≤ .035). Multivariate regression demonstrated significant reductions in the risk of surgery (hazard ratio [HR], 0.294; CI, 0.174-0.496; P < .001), hospitalization (HR, 0.465; CI, 0.310-0.697; P < .001), steroid use (HR, 0.628; CI, 0.427-0.923, P = .018), treatment change (HR, 0.705; CI, 0.510-0.972; P = .033), and phenotype progression (odds ratio [OR], 3.332; CI, 0.166-0.660; P = .002) with transmural improvement compared to no transmural improvement. The IPW wielded similar results. In patients with transmural improvement, stricturing disease was the most relevant predictor for requiring surgery (HR, 4.043; CI, 1.438-11.369; P = .008) and hospitalization (HR, 3.704; CI, 1.777-7.725; P = .005).

Transmural improvement may be an acceptable alternative in patients unable to reach transmural remission. However, it may be an insufficient target in patients with stricturing disease.