Ulcer Size After Induction Therapy Performs Better Than Symptom Assessment for Prediction of One Year Endoscopic Remission in Crohn's Disease: A Post Hoc Analysis

Background We evaluated whether postinduction ulcer size and patient-reported outcome (PRO) severity are associated with the achievement of 1-year endoscopic remission (ER) in patients with Crohn's disease (CD). Methods This post hoc analysis combined data from several clinical trials including 283 patients with baseline ulcers >= 5 mm with repeat endoscopy after ustekinumab or adalimumab induction therapy. Patient-reported outcomes including stool frequency (SF) and abdominal pain (AP) were measured by the Crohn's Disease Activity Index. Thresholds of SF >= 4 and/or AP >= 2 indicated moderately to severely active CD. Endoscopic remission was defined as Simple Endoscopic Score for CD (SES-CD) <3. Multivariate logistic regression models adjusted for confounders (including disease duration and treatment allocation) evaluated the relationships between postinduction ulcer size, PRO symptoms, and achievement of 1-year ER. Results Among the 131 CD patients who continued to have ulcers >= 5 mm after induction therapy, 48 (36.6%) achieved 1-year ER. Patients with postinduction ulcers >= 5 mm were approximately 5 times less likely to achieve 1-year ER than the 152 individuals who had small or no postinduction ulcers (odds ratio [OR], 0.20; 95% CI, 0.08-0.51, P = .001). In patients with ulcers >= 5 mm after induction, postinduction PRO scores (including PRO2 and PRO3) did not predict 1-year ER. Conclusions Crohn's disease patients with ulcers >= 5 mm after induction therapy are less likely to achieve 1-year ER. Postinduction PRO severity does not offer additional prognostic information. This may suggest that objective measures of disease such as endoscopic ulcer size should be considered over symptom assessments for determining clinical response to therapy and utilized in trials for maintenance therapy. Lay Summary Crohn's disease patients with ulcers >= 5 mm after induction therapy are less likely to achieve 1-year endoscopic remission. Postinduction patient-reported symptom severity does not offer additional prognostic information. Objective measures of disease such as endoscopic ulcer size should be considered over symptom assessments for determining clinical response to therapy.