Narula Neeraj, Wong Emily C L, Dulai Parambir S, Patel Jaiminkumar, Marshall John K, Yzet Clara, Jairath Vipul, Ungaro Ryan, Colombel Jean-Frederic, Reinisch Walter
Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
Clin Gastroenterol Hepatol. 2024 Aug;22(8):1687-1696.e6. doi: 10.1016/j.cgh.2024.02.009. Epub 2024 Feb 28.
BACKGROUND & AIMS: We assessed Modified Multiplier Simple Endoscopic Score for Crohn's Disease (MM-SES-CD) and Simple Endoscopic Score for Crohn's Disease (SES-CD) thresholds that are best associated with low likelihood of long-term disease progression.
Data from 61 patients with early Crohn's disease (CD) who participated in the CALM long-term extension study were used as the derivation cohort and validated using the McMaster inflammatory bowel disease database (n = 99). The primary outcome was disease progression (new internal fistula/abscess, stricture, perianal fistula or abscess, CD-related hospitalization or surgery) since the end of the CALM trial. Optimal MM-SES-CD and SES-CD thresholds were determined using the maximum Youden index. Receiver operating characteristic curve analyses compared threshold scores of remission definitions on disease progression.
In the derivation cohort, based on the maximum Youden index, the optimal thresholds associated with a low likelihood of disease progression were MM-SES-CD <22.5 and SES-CD <4. A significantly greater proportion of patients with a MM-SES-CD ≥22.5 had disease progression as compared with patients in the derivation cohort with MM-SES-CD <22.5 (10/17 [58.8%] vs 3/44 [6.8%]; P < .001). Similarly, a significantly greater number of patients with SES-CD ≥ 4 had disease progression compared with those with a SES-CD <4 (11/25 [44.0%] vs 2/36 [5.6%]; P < .001). Compared with other clinical or endoscopic remission definitions, which demonstrated poor to fair accuracy, MM-SES-CD <22.5 performed the best for predicting disease progression (area under the curve = 0.81; 95% confidence interval, 0.68-0.94; P < .001). These thresholds were confirmed in the validation cohort.
Achievement of MM-SES-CD <22.5 or SES-CD <4 in patients with ileocolonic or colonic CD is associated with low risk of disease progression and may be suitable targets in clinical trials and practice for endoscopic healing.
我们评估了与克罗恩病长期疾病进展低可能性最相关的改良乘数简单内镜评分（MM - SES - CD）和克罗恩病简单内镜评分（SES - CD）阈值。
将参与CALM长期扩展研究的61例早期克罗恩病（CD）患者的数据用作推导队列，并使用麦克马斯特炎症性肠病数据库（n = 99）进行验证。主要结局是自CALM试验结束以来的疾病进展（新的内瘘/脓肿、狭窄、肛周瘘或脓肿、CD相关住院或手术）。使用最大约登指数确定最佳MM - SES - CD和SES - CD阈值。受试者工作特征曲线分析比较了缓解定义的阈值分数对疾病进展的影响。
在推导队列中，基于最大约登指数，与疾病进展低可能性相关的最佳阈值为MM - SES - CD <22.5和SES - CD <4。与推导队列中MM - SES - CD <22.5的患者相比，MM - SES - CD≥22.5的患者疾病进展比例显著更高（10/17 [58.8%]对3/44 [6.8%]；P <.001）。同样，与SES - CD <4的患者相比，SES - CD≥4的患者疾病进展数量显著更多（11/25 [44.0%]对2/36 [5.6%]；P <.001）。与其他临床或内镜缓解定义相比，其准确性较差至中等，MM - SES - CD <22.5在预测疾病进展方面表现最佳（曲线下面积 = 0.81；95%置信区间，0.68 - 0.94；P <.001）。这些阈值在验证队列中得到证实。
回结肠或结肠CD患者达到MM - SES - CD <22.5或SES - CD <4与疾病进展风险低相关，可能是临床试验和内镜愈合实践中的合适目标。
