Optimal thresholds for disease progression in Crohn's disease

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Created On: 02/07/2024

To evaluate the endoscopic severity assessment tools for Crohn's disease (CD) i.e. simple endoscopic score for CD (SES-CD) and Modified Multiplier SES-CD (MM-SES-CD) thresholds in terms of disease progression of CD.

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Key take away

The ideal thresholds linked with reduced risk of progression of disease are Modified Multiplier-SES-CD of less than 22.5 and SES-CD of less than 4 which could be practical treatment goals, suitable for both clinical trials and real-world practice.

Background

Method

The clinical information of 61 patients diagnosed with early CD was drawn from the CALM extension study (derivation group) and validated using the McMaster inflammatory bowel disease database (number of patients = 99). Disease progression characterized as the occurrence of new fistulas and abscesses, intestinal stricture, hospitalization due to CD, or operation was considered the main outcome.

The highest Youden index helped to determine the satisfactory thresholds for MM-SES-CD and SES-CD. The threshold scores of remission definitions in terms of disease progression were later compared.

Result

As found, MM-SES-CD <22.5 and SES-CD <4 were the optimal thresholds linked with a reduced likelihood of disease progression in the derivation group.

Patients with MM-SES-CD ≥22.5 exhibited a notably higher rate of disease progression than MM-SES-CD <22.5. Similarly, patients with SES-CD ≥4 had a significantly higher incidence of disease progression than those with SES-CD <4, Table 1:

MM-SES-CD <22.5 showed superior performance in forecasting disease progression than other remission definitions (area under the curve=0.81). These thresholds were validated in the validation group.