Factors Predicting Loss of Remission in Crohn’s Disease Patients in Endoscopic Remission in the Real World Results From TARGET-IBD.

Challenge

Among CD patients in endoscopic remission, a substantial proportion experience loss of remission over time, but the real-world predictors of LOR—particularly the role of residual histologic inflammation despite endoscopic quiescence—had not been characterized in a large prospective US cohort.

Solution

The TARGET-IBD registry was analyzed to identify predictors of LOR among CD patients with steroid-free endoscopic remission, with histologic inflammation and biologic use at index colonoscopy evaluated as independent predictors using multivariable Cox proportional hazards regression.

Impact

Establishing that histologic inflammation despite endoscopic remission nearly doubles LOR risk in real-world CD patients provides evidence for deep remission—encompassing histologic healing—as the optimal treatment target, directly informing treat-to-target strategies for next-generation CD therapies.