CURE-CD: Capsule endoscopy-guided proactive treatment leads to fewer relapses in Crohn’s disease

A capsule endoscopy-guided treatment strategy led to fewer relapses than standard-of-care in patients with quiescent Crohn’s disease (CD) who were displaying high-risk video capsule endoscopy (VCE) features at baseline in the CURE-CD trial.

“Lewis scores of 350 and higher on VCE identify patients with a high risk of flares within the next 2 years, with a better predictive accuracy than faecal calprotectin,” explained Dr Shomron Ben-Horin (Tel-Aviv University, Israel) [1,2]. The current, prospective, randomised-controlled CURE-CD trial (NCT03555058) evaluated the efficacy of VCE as a guidance tool for patients with CD and small bowel involvement in clinical remission (n=60) [1].

At baseline, participants received VCE and those with a Lewis Score of 350 or higher (n=40) were randomised 1:1 to standard-of-care or to capsule endoscopy-guided proactive treatment for 24 months. “The proactive treatment regimen included biologic dose-escalation and initiating or swapping a biologic treatment,” added Dr Ben-Horin. Low-risk participants (n=20) continued on standard-of-care. The primary endpoint was the rate of relapse/disease complications in the high-risk population.

At 24 months, the clinical flare rate was 25% in the experimental arm and 70% in the control arm, meeting the primary endpoint (OR 0.14; 95% CI 0.04–0.57; P=0.006). “We also noted a trend towards fewer relapses in the low-risk standard-of-care group compared with the high-risk standard-of-care group (45% vs 70%; P=0.11), which was a secondary endpoint of the trial” (see Figure).

Figure: Main results of the CURE-CD trial at 24 months [2]



“High-risk patients with CD, as defined by baseline VCE scores, benefitted from a proactive treat-to-target strategy for the prevention of disease exacerbations,” concluded Dr Ben-Horin.

1. Ben-Horin S, et al. Capsule endoscopy-guided proactive treatment versus standard care in patients with quiescent Crohn’s disease: the CURE-CD randomized controlled trial. DOP29, 19^th Congress of ECCO, 21–24 February 2024, Stockholm, Sweden.
2. Ben-Horin S, et al. Lancet Gastroenterol Hepatol. 2019;4(7):519-528.

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Posted on 18 April, 202418 April, 2024