Predicting endoscopic remission in Crohn’s disease by the modified multiplier SES-CD (MM-SES-CD)

Narula, Neeraj
Wong, Emily C L
Colombel, Jean-Frederic
Sandborn, William J
Marshall, John Kenneth
Daperno, Marco
Reinisch, Walter
Dulai, Parambir S

¹ Department of Medicine (Division of Gastroenterology), McMaster University, Hamilton, Ontario, Canada
² Department of Medicine (Division of Gastroenterology), Mount Sinai School of Medicine, New York, New York, USA
³ Department of Medicine (Division of Gastroenterology), University of California San Diego School of Medicine, La Jolla, California, USA
⁴ Department of Internal Medicine (Division of Gastroenterology), Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
⁵ Department of Internal Medicine III (Division of Gastroenterology and Hepatology), Medical University of Vienna, Wien, Austria

Dr Neeraj Narula, Department of Medicine (Division of Gastroenterology), McMaster University, Hamilton, Canada; [email protected]

WR and PSD are joint senior authors.

Received December 07, 2020

Received in revised form March 11, 2021

Accepted March 15, 2021

Gut 71(6):p 1078-1087, June 2022. | DOI: 10.1136/gutjnl-2020-323799

Background and aims

The Simple Endoscopic Score for Crohn’s disease (SES-CD) is the primary tool for measurement of mucosal inflammation in clinical trials but lacks prognostic potential. We set to develop and validate a modified multiplier of the SES-CD (MM-SES-CD), which takes into consideration each individual parameter’s prognostic value for achieving endoscopic remission (ER) while on active therapy.

Methods

In this posthoc analysis of three CD clinical trial programmes (n=350 patients, baseline SES-CD ≥ 3 with confirmed ulceration), data were pooled and randomly split into a 70% training and 30% testing cohort. The MM-SES-CD was designed using weights for individual parameters as determined by logistic regression modelling, with 1-year ER (SES-CD < 3) being the dependent variable. A cut point score for low and high probability of ER was determined by using the maximum Youden Index and validated in the testing cohort.

Results

Baseline ulcer size, extent of ulceration and presence of non-passable strictures had the strongest association with 1-year ER as compared with affected surface area, with differential weighting of individual parameters across disease segments being observed during logistic regression. The MM-SES-CD was generated using this weighted regression model and 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). In comparison to the MM-SES-CD scoring model, the original SES-CD score lacks accuracy (AUC 0.60, 95% CI 0.55 to 0.65) for predicting the achievement of ER.

Conclusions

We developed and internally validated the MM-SES-CD as an endoscopic severity assessment tool to predict one-year ER in patients with CD on active therapy.