The article discusses a study on the effectiveness of a proactive treat-to-target strategy in patients with Crohn’s disease (CD) who are in remission but considered high-risk as determined by video capsule endoscopy. Key points include:
Study Design and Participants: The study, known as the CURE-CD trial, was a randomized controlled trial that included 60 patients with CD involving the small bowel who were in clinical remission. These patients underwent clinical, biomarker, and imaging checks, as well as video capsule endoscopies at baseline and every six months for up to 24 months.
Treatment Strategies: Patients with a high inflammatory activity (Lewis score ≥ 350) were randomized to either proactive treatment optimization (targeting video capsule endoscopy mucosal healing) or continued standard care for 24 months. Treatment intensification in the proactive group included therapeutic drug monitoring–based biologic dose-escalation, starting a biologic, or swapping a biologic.
Primary Outcome – Clinical Flare Rate: The primary outcome was the rate of clinical relapse (disease exacerbation or hospitalization/surgery) by 24 months in high-risk patients receiving standard care versus proactive care. The study found that clinical flare occurred in 25% of the high-risk proactive group versus 70% of the high-risk standard-care group, indicating a significant reduction in flares with the proactive strategy.
Implications and Future Directions: The study suggests that a treat-to-target approach tailored to high-risk patients can be more effective in preventing flares in CD. It also highlights the potential of using video capsule endoscopy to stratify the risk of patients with small-bowel Crohn’s disease and tailor their treatment accordingly.
In conclusion, the CURE-CD trial demonstrates that a proactive treat-to-target strategy guided by video capsule endoscopy can significantly reduce the rate of clinical flares in high-risk patients with Crohn’s disease in remission, suggesting a more personalized approach to managing the disease.