Normalization of C-Reactive Protein Predicts Better Outcome in Patients With Crohnʼs Disease With Mucosal Healing and Deep Remission

OBJECTIVES Therapeutic targets for Crohn's disease (CD) have evolved from clinical and biological remission to mucosal healing (MH) and deep remission (DR). MH is defined as disappearance of ulceration, whereas DR is defined as a combination of clinical remission and MH. Limited data are available regarding differences in long-term outcomes of these patients reaching these targets. We thus aimed to evaluate patients' long-term clinical outcomes using different composite remission parameters. METHODS We performed a retrospective cohort study comparing long-term outcomes of patients with different remission parameters, including MH and DR with or without normalization of C-reactive protein (CRPnorm). The primary outcome was CD-associated intestinal surgery, and secondary outcomes included CD-related hospitalizations, clinical relapse (CR), or endoscopic recurrence (ER). RESULTS One hundred ninety-five patients with MH at follow-up endoscopy were divided into 3 groups: DR-only (n = 53), DR + CRPnorm (n = 106), and MH-only (n = 36). At the follow-up (median 46.0 months), 25 patients had undergone CD-related bowel surgery, 44 had CD-related hospitalizations, and 66 experienced CR. Of 151 patients who underwent follow-up colonoscopy after the index colonoscopy for MH, 96 experienced ER. Among the 3 groups, patients in the DR + CRPnorm group had the lowest risk of clinical or endoscopic relapse. The DR group had a lower rate of CR than the MH-only group (P = 0.03); there was no difference in the rate of CD-related surgery, hospitalizations, or ER. DISCUSSION Patients with DR combined with a normalized CRP showed better outcomes than those with DR only. The outcomes of patients with MH were similar to those of patients with DR, except for shorter flare-free survival.