Intensive early treatment can delay progression of Crohn’s: CALM study

Thursday, 21 Mar 2019

Tight control of inflammation in early Crohn’s disease with a biologic can help prevent progression of the disease, long term follow-up of CALM study participants suggests.

Patients who achieved deep remission from Crohn’s disease with biomarker-driven adalimumab treatment had a low risk of complications when followed up three years after the end of the trial, according to results presented at ECCO 2019.

In the initial CALM study, 244 patients with early Crohn’s disease were randomised to either conventional treatment with adalimumab driven by symptoms or treatment escalation driven by biomarkers such as CRP and faecal calprotectin. Tight control resulted in 36.9% of patients achieving deep remission at one year, compared to 23.0% of those in the conventional treatment group. Complete endoscopic remission was achieved by 18% and 16.4% of patients respectively

In a follow up study by French researchers,  the patients who achieved endoscopic remission had a significantly lower level of Crohn’s disease progression compared to those who did not, over a mean of three years following the end of the CALM trial.

The primary outcome to reflect Crohn’s progression was a composite of any new fistula, abscess, stricture, Crohn’s disease related hospitalisation or surgery.

In multivariate analysis the Hazard Ratio for progression was 0.25 for patients with deep remission and 0.44 for those with endoscopic remission. A CDEIS (Crohn’s Disease Endoscopic Index of Severity) score of less than 4 was also associated with reduced progression (HR 0.44).

Study author Dr Clara Yzet, a gastroenterologist at University Hospital of Amiens, France, said the findings showed that a treat-to-target approach with a biologic in early Crohn’s disease could reduce the long term risk of disease complications by 75% in those who achieved deep remission.

“Reaching the targets of endoscopic and deep remission early in the disease course can result in long term disease modification in Crohn’s disease,” she said.

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