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A Treat-to-Target Strategy Guided by Pan-Enteric Evaluation in Children With Crohn's Disease Improves Outcomes at 2 Years. | LitMetric

AI Article Synopsis

  • A treat-to-target approach for managing Crohn's disease in children was evaluated over a two-year period to determine its effectiveness in achieving mucosal healing (MH) and overall patient outcomes.
  • Out of the initial 48 patients, 46 completed the follow-up at 104 weeks, with 93% of those who had achieved MH at 52 weeks maintaining it over the next year.
  • Patients who achieved and maintained MH had significantly lower rates of steroid use, treatment escalation, hospitalization, and clinical relapses compared to those without MH, indicating the long-term benefits of this management strategy.

Article Abstract

Background And Aims: It is uncertain whether a treat-to-target approach could be an effective strategy for improving outcomes in children with Crohn's disease (CD). Previously, we reported mucosal healing (MH) and deep remission rates throughout the intestinal tract by performing 3 pan-enteric capsule assessments and using a treat-to-target strategy over 52 weeks in children with CD. This report describes the outcomes of this approach at 104 weeks.

Methods: Children with known CD who completed the 52-week protocol repeated pan-enteric capsule endoscopy (PCE) at 104 weeks. Results at weeks 52 and 104 were compared, and long-term outcomes between patients, with and without MH, were calculated using an intention-to-treat analysis of clinical relapse, need for steroids, treatment escalation, hospitalization, and surgery.

Results: Of the previous study cohort of 48 patients, 46 (96%) were available for this extension study (28 [61%] of 46 with MH and 18 [39%] of 46 without MH at 52 weeks). When evaluated at 104 weeks, MH was maintained in 93% of patients with MH at 52 weeks. In the intention-to-treat analysis, complete MH at 52 weeks was associated with reduced risk of steroid use (log-rank P < .0001), treatment escalation (log-rank P < .0001), hospitalization (log-rank P < .0001), and clinical relapse (log-rank P < .0001).

Conclusions: When a PCE-based, treat-to-target strategy is employed, MH is sustainable (93%) over a 1-year period and is correlated with improved patient outcomes, including reduced need for steroids, treatment escalation, hospitalization, and clinical relapses at 104 weeks.ClinicalTrials.gov number: NCT03161886.

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Source
http://dx.doi.org/10.1093/ibd/izad173DOI Listing

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