David
Co-Founder
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- Naples, Florida
The article, "Mucosal Healing in IBD: Essential or Cosmetics?" by Peter Bossuyt and Geert D'Haens is a part of the book, "Advanced Therapy in Inflammatory Bowel Disease" which I recommend to anyone interested in the deeper medical side of Crohn's Disease. This thread will contain what I gleam from the article and it is open for discussion as well.
This article is on pages 637-641 and is supported by 37 references.
Rather than just symptom relief, the authors are interested in the importance of intestinal mucosa healing.
- Mucosal healing has been neglected and isn't even a variable in indexes such as the CDAI and [wiki]Harvey Bradshaw Index[/wiki].
- Mucosal healing is now thought to potentially be an important factor for determining if a treatment is successful. Some are even proposing it be necessary for a new treatment to gain regulatory approval.
- Mucosal healing and histologic (microscopic) healing are not the same thing. There can be mucosal healing but microscopic inflammation may persist.
- You can achieve "clinical remission" (absence of discernible symptoms) yet your mucosa may not be healed.
- Corticosteroids don't seem to help the mucosa heal or prevent recurrence of Crohn's Disease after surgery. One study found that 92% of patients on steroids achieved CLINICAL remission within 7 weeks but only 29% had mucosal healing evident by endoscopy.
- A study of patients on Remicade found that those who were on steroids at the same time had a LOWER incidence of mucosal healing than those just on the Remicade.
- Azathioprine and 6-MP are found to help with mucosal healing. In one small study of patients with ileocecal resection and subsequent relapse, 6 had complete mucosal healing and 5 near complete. Another study found 83% of patients on AZA had complete or near complete mucosal healing after one year.
- Only one study on Methotrexate and that was in the 80's. 5 of 14 had some mucosal healing.
- A study on Infliximab showed mucosal healing (defined as disappearance of ulcerations) after 4 weeks in 74% of patients with disease in the ileum and 96% in the rectum.
- "Scheduled therapy" of Infliximab is shown to have better mucosal healing rates than periodic treatments with complete mucosal healing in 31% of the scheduled therapy patients and 0% of the periodic patients at the 10 week mark and 50%/7% at week 54.
- In another trial where Infliximab was given 3 times then Azathioprine was used as a maintenance medication, mucosal healing was evident in 73% of patients after two years versus 30% who used conventional step up treatment. At year four, no mucosal lesions correlated with higher remission rates and those patients were four times more likely to be in remission or to need steroids.
- Humira was shown to induce mucosal healing in 27% of patients at week 12 (versus 13% for placebo) and 24% at week 52 versus 0% of the placebo.
- A study of Ulcerative Colitis patients found that new flares after 1 year were at 4% in patients with clinical AND mucosal remission versus 30% for those with just clinical remission. Another study found the rates to be 23% versus 80%.
- In an Ulcerative Colitis trial with Remicade, when there was fast induction of mucosal healing, there was a fourfold increase in clinical remission at week 30. They also feel that chronically inflamed mucosa increases cancer risks.
- For mesalazine and Ulcerative Colitis, 33% had complete mucosal healing verus 16% in the placebo.
- A study showcased that 4g 5-asa enema mucosal healing was seen in 93$ versus 54% of patients doing hydrocortisone enemas.
- In UC patients, corticosteroids showed mucosal healing in 52% of patients versus 32% for placebo.
- For UC patients, Azathioprine is shown to induce clinical and mucosal remission in 50% of patients versus 35% with 5-ASA
- For UC patients, Infliximab was shown to heal 60% of patient's mucosa versus 32% who had the placebo.
- Lower colectomy rates are seen in UC patients with mucosal healing.
This article is on pages 637-641 and is supported by 37 references.
Rather than just symptom relief, the authors are interested in the importance of intestinal mucosa healing.
- Mucosal healing has been neglected and isn't even a variable in indexes such as the CDAI and [wiki]Harvey Bradshaw Index[/wiki].
- Mucosal healing is now thought to potentially be an important factor for determining if a treatment is successful. Some are even proposing it be necessary for a new treatment to gain regulatory approval.
- Mucosal healing and histologic (microscopic) healing are not the same thing. There can be mucosal healing but microscopic inflammation may persist.
- You can achieve "clinical remission" (absence of discernible symptoms) yet your mucosa may not be healed.
- Corticosteroids don't seem to help the mucosa heal or prevent recurrence of Crohn's Disease after surgery. One study found that 92% of patients on steroids achieved CLINICAL remission within 7 weeks but only 29% had mucosal healing evident by endoscopy.
- A study of patients on Remicade found that those who were on steroids at the same time had a LOWER incidence of mucosal healing than those just on the Remicade.
- Azathioprine and 6-MP are found to help with mucosal healing. In one small study of patients with ileocecal resection and subsequent relapse, 6 had complete mucosal healing and 5 near complete. Another study found 83% of patients on AZA had complete or near complete mucosal healing after one year.
- Only one study on Methotrexate and that was in the 80's. 5 of 14 had some mucosal healing.
- A study on Infliximab showed mucosal healing (defined as disappearance of ulcerations) after 4 weeks in 74% of patients with disease in the ileum and 96% in the rectum.
- "Scheduled therapy" of Infliximab is shown to have better mucosal healing rates than periodic treatments with complete mucosal healing in 31% of the scheduled therapy patients and 0% of the periodic patients at the 10 week mark and 50%/7% at week 54.
- In another trial where Infliximab was given 3 times then Azathioprine was used as a maintenance medication, mucosal healing was evident in 73% of patients after two years versus 30% who used conventional step up treatment. At year four, no mucosal lesions correlated with higher remission rates and those patients were four times more likely to be in remission or to need steroids.
- Humira was shown to induce mucosal healing in 27% of patients at week 12 (versus 13% for placebo) and 24% at week 52 versus 0% of the placebo.
- A study of Ulcerative Colitis patients found that new flares after 1 year were at 4% in patients with clinical AND mucosal remission versus 30% for those with just clinical remission. Another study found the rates to be 23% versus 80%.
- In an Ulcerative Colitis trial with Remicade, when there was fast induction of mucosal healing, there was a fourfold increase in clinical remission at week 30. They also feel that chronically inflamed mucosa increases cancer risks.
- For mesalazine and Ulcerative Colitis, 33% had complete mucosal healing verus 16% in the placebo.
- A study showcased that 4g 5-asa enema mucosal healing was seen in 93$ versus 54% of patients doing hydrocortisone enemas.
- In UC patients, corticosteroids showed mucosal healing in 52% of patients versus 32% for placebo.
- For UC patients, Azathioprine is shown to induce clinical and mucosal remission in 50% of patients versus 35% with 5-ASA
- For UC patients, Infliximab was shown to heal 60% of patient's mucosa versus 32% who had the placebo.
- Lower colectomy rates are seen in UC patients with mucosal healing.