Mucosal healing after 3 months of conventional IBD treatment: real life data

Background: Mucosal healing has become a primary target in the treatment of inflammatory bowel disease (IBD), as it is associated with an improved disease course. However, real life data concerning mucosal healing after conventional treatment are scarce. Methods: Our aim was to assess the rate of mucosal healing and clinical remission after 3 months of conventional treatment in a cohort of newly diagnosed IBD patients. 171 patients with ulcerative colitis [UC; N=123 (72%)] or Crohn's disease [CD; N=48 (28%)] aged 16 years and above, were consecutively included in a prospective study. Demographic data, medication, Partial Mayo Score (PMS) for UC or Harvey Bradshaw Index (HBI) for CD, fecal calprotectin and CRP were obtained, and colonoscopy performed at baseline and after 3 months of conventional treatment. Inflammatory activity was assessed according to the Mayo Endoscopic Score (MES-UC) for UC and the Simple Endoscopic Score (SES-CD) for CD. Baseline data are given in Table 1. Mucosal healing was defined as MES-UC ≤1 or SES-CD ≤2, clinical remission as PMS ≤2 or HBI <5. Results: Mucosal healing was achieved by 101 (59%) and clinical remission by 100 (58%) of all patients, whereas 74 (43%) reached a combined endpoint of mucosal healing and clinical remission (Figure 1A). Eighty-six (70%) UC patients achieved mucosal healing, 68 (55%) clinical remission and 60 (49%) combined mucosal healing and clinical remission (Figure 1B). Median PMS was reduced from 5 to 1 (p<0.001), CRP from 6.4 to 1.9 mg/L (p<0.001) and f-calprotectin from 620 to 67 mg/kg (p<0.001). Fifteen CD patients (31%) achieved mucosal healing, 32 (67%) clinical remission and 14 (29%) combined mucosal healing and clinical remission (Figure 1C). Figure 1. Outcomes. Median HBI was reduced from 5 to 3 (p=0.01), CRP from 7.9 to 4.1 mg/L (p=0.002) and f-calprotectin from 160 to 38 mg/kg (p<0.001). The mucosal healing rate was higher in UC than in CD patients (p<0.001); no difference in clinical remission was observed (p=0.18). Conclusions: Nearly 60% of newly diagnosed IBD patients achieved mucosal healing as well as clinical remission following three months of conventional treatment in a real life setting. Mucosal healing rate was significantly higher in UC than in CD patients. Conventional treatment appears effective for mucosal healing in UC patients.