VCE-Guided Treat-to-Target Strategy Reduces Flares in Crohn’s Disease Remission
A randomized controlled trial published in Gastroenterology, has shown that video capsule endoscopy (VCE)–guided treat-to-target strategies significantly reduce clinical flares in patients with small bowel Crohn’s disease (CD) in corticosteroid-free clinical remission. The study highlights the utility of mucosal assessment in driving treatment optimization, even in asymptomatic patients.
The trial enrolled 60 patients with L1 or L3 CD and Crohn’s Disease Activity Index (CDAI) <150. All patients underwent VCE at baseline. Those with a Lewis inflammatory score (LS) ≥350 were classified as high risk and randomized to either a proactive treat-to-target strategy or standard care. Those with LS <350 continued standard care.
By 24 months, clinical exacerbation—defined as a CDAI increase of >70 points and score >150, or hospitalization/surgery—occurred in only 25% (5/20) of high-risk patients assigned to treat-to-target care, compared to 70% (14/20) of high-risk patients who received standard care (odds ratio, 0.14; 95% CI, 0.04–0.57; P = .006).
“Treatment intensification in the proactive group included biologic dose escalation, initiation of a new biologic, or switching biologics,” the authors reported. Repeat VCE was used every six months to guide management in the treat-to-target group.
Mucosal healing, defined by LS <350, was significantly more likely in the treat-to-target group (odds ratio, 4.5; 95% CI, 1.7–17.4; P = .03). Among patients who continued standard care, higher baseline LS was numerically associated with disease relapse, although this did not reach statistical significance (P = .07).
The study also demonstrated the safety of VCE, with only one instance (0.4%) of transient capsule retention.
“A VCE-guided treat-to-target strategy for patients with CD in remission confers superior clinical outcomes compared with continued standard care,” the investigators concluded.
For clinicians managing CD, this study supports integrating VCE into longitudinal treatment planning—even in patients in clinical remission—to detect subclinical inflammation and guide early intervention.
Reference
Ben-Horin S, Lahat A, Ungar B, et al. Capsule endoscopy-guided proactive treat-to-target versus continued standard care in patients with quiescent Crohn's disease: A randomized controlled trial. Gastroenterology. Published online March 13, 2025. doi:10.1053/j.gastro.2025.02.031
