Patients With IBD Achieving Clinical Remission More Likely to Maintain Clinical Remission at 1 Year

Results of a meta-analysis showed that patients with moderate-to-severe inflammatory bowel disease (IBD) who were able to achieve clinical remission, compared with response to induction therapy, were 1.6 times more likely to maintain clinical remission at week 52, according to data presented at Digestive Disease Week (DDW) 2023.¹ Investigators emphasized that early remission was a strong predictor of favorable long-term outcomes in this patient population who were treated with advanced therapies.

“Risk stratification to identify patients with high-risk IBD most likely to achieve long-term benefit with pharmacotherapy is needed,” wrote Babu Mohan, MBBS, associated with Gastroenterology and Hepatology at the University of Utah Health, and colleagues. “Early achievement of remission is a potentially favorable prognostic factor; however, the magnitude of benefit is unclear.”

Investigators conducted a systematic review and meta-analysis to determine the rates of achieving and maintaining clinical remission during maintenance therapy within a patient population comprised of moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD) treated with advanced therapies via comparison of those who achieved early clinical-remission and those with clinical response without remission during induction therapy.

A systemic literature review of databases, including Embase, MedLine, and Scopus, through April 30, 2022, for phase 2 and phase 3 randomized, double-blind, placebo-controlled trials (RCT) of induction and maintenance with advanced therapies in patients with IBD. Trials that reported outcomes of patients who achieved clinical remission compared with clinical response with induction therapy, defined as within 4-14 weeks, were included. Summary estimates and subgroup analysis between the CD and UC cohorts were calculated using random-effects meta-analysis.
Ultimately, 21 RCTs, including 17 trials of biologic agents and 4 trials of oral small molecules, reported on 7250 patients (4712 patients treated with active therapy and 2538 patients treated with placebo). During the maintenance therapy period, with a median 52-week follow-up, patients who were treated with advanced therapies who obtained clinical remission during the induction therapy had 1.6-times higher risk ratio (RR; 95% confidence [CI], 1.5-1.8) of maintaining remission when compared with those who achieved clinical response without remission (pooled rate of remission: 65% [95% CI, 58.9-70.7] vs 36.1% [38.1-43.7]), with low heterogeneity (I2=31%).

During the subgroup analysis, the higher likelihood of favorable outcomes was noted in patients classified as clinical remitter vs responders in the CD cohort (7 trials; RR, 1.6; 95% CI, 1.3-1.9), UC cohort (12 trials; RR, 1.7; 95% CI, 1.5-1.8), patients treated with biologics (12 trials; RR, 1.6; 95% CI, 1.4-1.8), and patients treated with oral small molecules (7 trials; RR, 1.7; 95% CI, 1.5-1.9). Additionally, remitters compared with responders who received placebo therapy during the maintenance period were more likely to achieve remission during long-term follow-up (12 trials; RR, 1.7; 95% CI, 1.5-2.0).

References

1. ^{Mohan B, Fatima N, Rasool Khan S, Chandan S, et al. LONG-TERM OUTCOMES OF CLINICAL REMITTERS VS RESPONDERS TO INDUCTION THERAPY IN MODERATE TO SEVERE INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW & META-ANALYSIS. Abstract presented at Digestive Disease Week (DDW) 2023 Annual Meeting. Chicago, IL. May 6-10, 2023.}