P-016 YI Mucosal Healing Is Associated with Improved Long-Term Outcomes in Crohn's Disease: A Systematic Review and Meta-analysis. (March 2016)

• Record Type: Journal Article
• Authors: Shah, Shailja; Colombel, Jean-Frédéric; Sands, Bruce; Narula, Neeraj
• Is Part Of: Inflammatory bowel diseases. Volume 22(2016:Mar.)Supplement 1
• Publication Date: 2016-03
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000480062.50995.b2
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Treating to achieve clinical remission (CR) has neither been shown to improve Crohn's disease (CD) outcomes nor alter the natural course of disease. It is unclear whether targeting more objective measures like mucosal healing (MH) is associated with improved long-term outcomes. We performed a systematic review and meta-analysis to identify and analyze studies comparing long-term outcomes in patients with active CD who achieve early MH compared to those who do not. Methods: A systematic literature search of PubMed, Embase, and Cochrane Library was performed to identify observational or interventional studies with a prospective cohort of active CD patients that included long-term outcomes of patients who achieved MH compared to those who did not. The primary outcome was long-term clinical remission (CR). Secondary outcomes included CD-related surgery-free rate and long-term MH rate. Pooled odds-ratios (OR) and 95% confidence intervals (CI) were calculated for each outcome. Results: Twelve high-quality studies with 673 active CD patients were eligible for inclusion in the meta-analysis. Patients who achieved early MH had a pooled OR of 2.80 (95% CI, 1.91–4.10) for achieving long-term CR, 2.22 (95% CI, 0.86–5.69) for CD-related surgery-free rate, and 14.30 (95% CI, 5.57–36.74) for long-term MH. Sensitivity analyses suggested no significant difference in outcomes if MH was achieved on biologics compared to non-biologics. Achieving complete MH (SES-CD of 0 and/or complete absence of mucosal ulceration) was associated with even higher pooled ORs for achieving long-term CR and MH. There was no publication bias and no significant heterogeneity among the included studies. Conclusions: This meta-analysis of over 670 active CD patients suggests that achieving MH, either with biologic or non-biologic therapy, is associated with improved long-term outcomes at 1 year and beyond. The extent to which poor prognostic factors such as fistulizing disease, early surgical intervention, early corticosteroid use, and early age at diagnosis, among others, predict disease course relative to the severity of mucosal lesions remains to be evaluated in well-designed prospective trials. Based on our findings and in the absence of published prospective randomized control trials, it seems reasonable to target MH (in addition to clinical improvement) as a goal of CD treatment.