Validation of the Modified Multiplier of SES-CD (MM-SES-CD) to Predict Endoscopic Healing in Crohn’s Disease: A Post Hoc Analysis of the SEAVUE Trial

BACKGROUND: The modified multiplier of the SES-CD (MM-SES-CD) has been shown to predict future endoscopic healing (EH) in patients with Crohn's disease. The purpose of this study was to validate baseline MM-SES-CD categories of severity and determine their prognostic value for predicting 1-year EH. METHODS: Participants in the SEAVUE trial (n = 386) were classified based on baseline endoscopic disease severity using MM-SES-CD cut-offs as mild (≥ 22.5 to < 31), moderate (≥ 31 to < 45), and severe (≥ 45) disease. The primary outcome was achieving 1-year endoscopic healing (EH) as measured by the MM-SES-CD score (< 22.5). Secondary outcomes included clinical and biochemical remission at 1 year based on patient-reported outcomes and fecal calprotectin (FCP)(< 250 mcg/g). RESULTS: MM-SES-CD < 22.5 at 1 year was achieved in 62.0% of patients with baseline mild endoscopic disease, 48.6% with moderate disease, and 33.8% with severe disease (P < .001). A similar trend was observed for patient-reported outcome (PRO-2) clinical remission, which was reached in 78.9% of patients with baseline mild endoscopic disease, 72.9% of those with moderate, and 66.2% of those with severe disease (P = 0.09). The likelihood of fecal calprotectin (FCP) remission was significantly associated with baseline endoscopic disease severity (P = .008). CONCLUSION: Baseline MM-SES-CD-based cutoffs for endoscopic disease severity show prognostic value for the likelihood of achieving 1-year EH, PRO2 remission, and FCP remission. These findings suggest that the MM-SES-CD can be used both to measure baseline endoscopic disease severity and predict outcomes at 1 year in patients with moderate to severe CD.