Systematic review with meta‐analysis: mucosal healing is associated with improved long‐term outcomes in Crohn's disease

Summary Background Clinical manifestations of Crohn's disease ( CD ) do not reliably correlate with endoscopic activity. While treating to achieve clinical remission ( CR ) has neither proven to improve CD outcomes nor alter the natural disease course, it is unclear whether targeting objective measures like mucosal healing ( MH ) is associated with improved long‐term outcomes. Aim To perform a systematic review and meta‐analysis comparing long‐term outcomes in active CD patients who achieve MH compared to those who do not. Methods We performed a systematic literature search to identify studies with prospective cohorts of active CD patients that included outcomes of patients who achieved MH at first endoscopic assessment ( MH 1) compared to those who did not. The primary outcome was long‐term (≥50 weeks) CR . Secondary outcomes included CD ‐related surgery‐free rate, hospitalisation‐free rate and long‐term MH rate. Pooled odds ratio ( OR ) and 95% confidence intervals ( CI ) were calculated. Results Twelve studies with 673 patients met inclusion criteria. Patients achieving MH 1 had a pooled OR of 2.80 (95% CI , 1.91–4.10) for achieving long‐term CR , 2.22 (95% CI , 0.86–5.69) for CD ‐related surgery‐free rate, and 14.30 (95% CI , 5.57–36.74) for long‐term MH . Sensitivity analyses suggested no difference in outcomes if MH 1 was achieved on biologics vs. non‐biologics. No significant publication bias or heterogeneity was detected. Conclusions Achieving MH 1 is associated with increased rates of long‐term clinical remission, and maintenance of mucosal healing in active Crohn's disease and may therefore be a reasonable therapeutic target.