TOPLINE:
A systematic review of trial data finds that people who experience remission soon after induction therapy are 65% likelier to see long-term benefit than those who have only a partial response.
METHODOLOGY:
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The data were from 19 randomized controlled trials of small-molecule and biologic treatments of adults with moderate to severe Crohn’s disease or ulcerative colitis. The median follow-up was of 1 year.
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All studies reported remission rates at 1 year as well as response to induction therapy.
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The review included trials in which TNF antagonists, anti-integrins, and anti-IL 23 and anti-IL 12/23 agents were used.
TAKEAWAY:
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Patients on active therapy who experienced remission within 4–14 weeks of induction treatment were 65% more likely to have remained in remission at 1 year compared with patients who experienced only a partial response.
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Patients who experienced remission with induction therapy and who received placebo during maintenance therapy were 72% more likely to stay in remission compared with responders who received placebo during the maintenance phase.
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The findings were consistent between diseases and drug classes.
IN PRACTICE:
Early remission is a good predictor of long-term response to advanced therapies in inflammatory bowel disease. However, concomitant corticosteroid use is more limited in clinical trials than in practice. Providers “should be cautious in classifying patients as early remitters vs responders” when steroids are used during induction, the study authors say.
STUDY DETAILS:
Babu P. Mohan, MD, of University of Utah Health in Salt Lake City, led the study, which was funded by NIH grants to its corresponding author, Siddharth Singh, MD, of the University of California, San Diego.
LIMITATIONS:
The maintenance phase of the included trials was not stratified by remission or response status at trial entry. Patients’ characteristics and disease characteristics of those who experienced remission and responders might differ. Long-term remission was measured only to 1 year.
DISCLOSURES:
Singh has received fees and/or grants from Pfizer and AbbVie. Four of his 11 co-authors have received consulting or advisory board fees from manufacturers.
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