Can the Modified Multiplier of the SES-CD Better Predict Endoscopic Remission in Patients With Crohn's Disease?

In addition to achieving clinical remission, another key endpoint of the medical management of Crohn's disease (CD) is to attain endoscopic improvement or remission. Using validated endoscopic scores is essential in quantitating the degree of inflammatory changes found on colonoscopy. The Simple Endoscopic Score for Crohn’s Disease (SES-CD) is easily applicable in practice and used in registration trials for medications being studied for the treatment of CD. A modification of the SES-CD, called the Modified Multiplier of the SES-CD (MM-SES-CD), has been developed to assign greater significance to substantial endoscopic lesions in order to better account for heterogeneity of CD endoscopic findings.

The aim of this study was to establish MM-SES-CD categories that stratify CD endoscopic burden as mild, moderate, and severe disease based on the likelihood of achieving endoscopic remission (ER) after 1 year of active therapy. This post hoc study analyzed pooled data from 3 CD clinical trials that included 350 patients with a baseline SES-CD of ≥3 and ulceration. MM-SES-CD severity was classified as very mild/remission, mild, moderate, and severe, which was predictive of 1-year ER (50%, 30.3%, 21.7%, 8.8%, respectively; P<.001). Patients with lower scores had higher rates of 1-year clinical remission. In addition, 75 patients with isolated ileal disease were classified with an MM-SES-CD threshold of mild, moderate, or severe, which was predictive of 1-year ileal ER (66.7%, 33.3%, 13.3%, respectively; P=.027).