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Article Dans Une Revue Gastroenterology Année : 2020

Deep Remission at 1 Year Prevents Progression of Early Crohn's Disease

1 MSSM - Icahn School of Medicine at Mount Sinai [New York]
2 CHU Amiens-Picardie
3 Imelda General Hospital
4 AZ Delta Roeselare
5 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
6 University of Calgary
7 Medizinische Universität Wien = Medical University of Vienna
8 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
9 Fondazione Policlinico Universitario Agostino Gemelli IRCCS
10 Timisoara Hospital [Timisoara, Romania]
11 John Radcliffe Hospital [Oxford University Hospital]
12 CHU Nice - Centre Hospitalier Universitaire de Nice
13 University Hospitals Leuven [Leuven]
14 Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.
15 PERITOX - Périnatalité et Risques Toxiques - UMR INERIS_I 1
16 IRCCS Milan - Istituto Clinico Humanitas [Milan]
17 UW - University of Warsaw
18 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
19 Skane University Hospital [Lund]
20 UMF lasi - University of Medicine and Pharmacy "Grigore T.Popa" Iasi
21 CHU Marseille
22 UMPCD - University of Medicine and Pharmacy “Carol Davila” Bucharest
23 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
24 Service d'Hépato-gastro-entérologie [CHRU Nancy]
25 CHU Bordeaux
26 IIS Aragón - Instituto de Investigación Sanitaria de Aragón [Zaragoza]
27 CAU - Christian-Albrechts-Universität zu Kiel = Christian-Albrechts University of Kiel = Université Christian-Albrechts de Kiel
28 Uppsala University
29 Örebro University
30 Abbvie Inc. [North Chicago]
Clara Yzet
Peter Bossuyt
Thomas Vanasek
  • Fonction : Auteur
Oleksandr Golovchenko
  • Fonction : Auteur
Olga Prymak
  • Fonction : Auteur
Silvio Danese
Melanie Serrero
  • Fonction : Auteur
David Laharie
  • Fonction : Auteur
John P. Wright
  • Fonction : Auteur
Irina Gubonina
  • Fonction : Auteur
Satoshi Motoya
  • Fonction : Auteur
James W. Butler
  • Fonction : Auteur


BACKGROUND & AIMS: We investigated the effects of inducing deep remission in patients with early Crohn's disease (CD). METHODS: We collected follow-up data from 122 patients (mean age, 31.2 +/- 11.3 y) with early, moderate to severe CD (median duration, 0.2 years; interquartile range, 0.1-0.5) who participated in the Effect of Tight Control Management on CD (CALM) study, at 31 sites, representing 50% of the original CALM patient population. Fifty percent of patients (n = 61) were randomly assigned to a tight control strategy (increased therapy based on fecal level of calprotectin, serum level of C-reactive protein, and symptoms), and 50% were assigned to conventional management. We categorized patients as those who were vs were not in deep remission (CD endoscopic index of severity scores below 4, with no deep ulcerations or steroid treatment, for 8 or more weeks) at the end of the follow-up period (median, 3.02 years; range, 0.05-6.26 years). The primary outcome was a composite of major adverse outcomes that indicate CD progression during the follow-up period: new internal fistulas or abscesses, strictures, perianal fistulas or abscesses, or hospitalization or surgery for CD. Kaplan-Meier and penalized Cox regression with bootstrapping were used to compare composite rates between patients who achieved or did not achieve remission at the end of the follow-up period. RESULTS: Major adverse outcomes were reported for 34 patients (27.9%) during the follow-up period. Significantly fewer patients in deep remission at the end of the CALM study had major adverse outcomes during the follow-up period (P =.01). When we adjusted for potential confounders, deep remission (adjusted hazard ratio, 0.19; 95% confidence interval, 0.070.31) was significantly associated with a lower risk of major adverse outcome. CONCLUSIONS: In an analysis of follow-up data from the CALM study, we associated induction of deep remission in early, moderate to severe CD with decreased risk of disease progression over a median time of 3 years, regardless of tight control or conventional management strategy.

Dates et versions

hal-03551527 , version 1 (01-02-2022)



Ryan C. Ungaro, Clara Yzet, Peter Bossuyt, Filip J. Baert, Thomas Vanasek, et al.. Deep Remission at 1 Year Prevents Progression of Early Crohn's Disease. Gastroenterology, 2020, 159 (1), pp.139-147. ⟨10.1053/j.gastro.2020.03.039⟩. ⟨hal-03551527⟩
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