The modified multiplier of the Simple Endoscopic Score for Crohn disease (MM-SES-CD) is significantly more accurate compared with the Simple Endoscopic Score for Crohn disease (SES-CD) for predicting the achievement of endoscopic remission (ER). These findings were reported in Gut.
The measurement and quantification of mucosal inflammation in clinical trials for CD is accomplished with the assistance of endoscopic indices. The primary tool for measuring mucosal inflammation in clinical trials for CD is the SES-CD. However, this tool is known to lack prognostic potential. Therefore, a group of researchers sought to develop and validate a MM-SES-CD, which predicts the achievement of ER while on active therapy by taking into consideration each individual parameter’s prognostic value.
A total of 350 patients were included in the analysis. All subjects had endoscopic assessments with scoring available at baseline with SES-CD > 3 and confirmed mucosal ulceration.
Data was collected from 3 previous CD clinical trials: UNITI, CTP13, and Extend. These data were then pooled and randomly split into a 70% training cohort and 30% testing cohort. The MM-SES-CD was designed by assigning appropriate weights for individual parameters which were determined by logistic regression modeling, with 1-year ER (SES-CD <3) being the dependent variable. The maximum Youden Index was used to determine the cut point score for low and high probability of ER. The positive and negative predictive values (PPV and NPV) and positive and negative likelihood ratios were then validated in the testing cohort.
The investigators found that baseline ulcer size, extent of ulceration, and the presence of non-passable strictures had the strongest association with 1-year ER when compared with affected surface area. In addition, during logistic regression, differential weighing of individual parameters across disease segments were observed.
Using results from the multivariable logistic regression analyses, the MM-SES-CD demonstrated strong discrimination for ER in the training dataset (area under the receiver operator curve [AUC] 0.83; 95% CI, 0.78 to 0.94) and in the testing dataset (AUC, 0.82; 95% CI, 0.77 to 0.92).
The MM-SES-CE was significantly more accurate compared with the original SES-CD scoring approach (AUC, 0.60; 95% CI, 0.55 to 0.65) for predicting the achievement of ER (comparison of AUCs on testing cohort for MM-SES-CD vs original SES-CD, P =.0052).
This study had multiple limitations, such as the lack of external validation in a routine practice cohort and lack of assessment for its prognostic value in predicting future risk of surgery directly. Additionally, further validation among the mild-moderate CD population and biologic-experienced patients is needed.
These observations indicated that the MM-SES-CD is highly accurate for predicting 1 year ER in patients with CD on active therapy. Findings from this posthoc analysis suggested that the use of MM-SES-CD could have meaningful applications within both clinical trials and clinical practice with regard to ER. However, future studies are warranted to ascertain the MM-SES-CD accuracy in predicting longer term outcomes.
Disclosure: Multiple authors declared industry affiliations. Please refer to the original article for a full list of disclosures.
Narula N, Wong ECL, Colombel J-F, el al. Predicting endoscopic remission in Crohn’s disease by the modified multiplier SES-CD (MM-SES-CD). Gut. Published online March 25, 2021. doi: 10.1136/gutjnl-2020-323799