Disease Clearance is not Synonymous with Cure

To the Editors,

We thank Rao and colleagues for their letter to our systematic review and expert consensus. The concept of disease clearance originates from dermatology and has been extrapolated to ulcerative colitis (UC). It is not synonymous with cure, but it currently represents the deepest degree of remission achievable in clinical practice and in clinical trials. There are several definitions of “deep remission,” and none of those available are comparable to disease clearance.^1,2 Deep remission generally refers to concomitant clinical and endoscopic remission.^3,4 Disease clearance by simultaneously evaluating all crucial aspects of UC patient management (clinical, endoscopic, and histologic) allows us to aspire to improved disease control. To date, it is not known whether disease clearance is a more accurate predictor of disease outcomes than histology alone. However, since there are discrepancies between histology, endoscopy, and patient symptoms, disease clearance may provide a more precise estimate of patients in remission.⁵ Finally, as also indicated by one of the statements of our consensus (approved with 100% agreement), we are aware that the concept of disease clearance is not fixed and could evolve in the near future to include crucial aspects such as the patient’s quality of life. Clinical trials to demonstrate the benefit of disease clearance vs other outcomes (eg, clinical, endoscopic, histological, or endoscopic + histological) are warranted.

Funding

The authors received no financial support for research, authorship, and/or publication of this article.

Conflicts of interest

F.D’A. has served as a speaker for Sandoz, Janssen, Galapagos, and Omega Pharma; he has also served as advisory board member for Abbvie, Ferring, Galapagos, and Nestlè. L.P.B. has served as a consultant for AbbVie, Alimentiv, Alma Bio Therapeutics, Amgen, Applied Molecular Transport, Arena, Biogen, BMS, Celltrion, CONNECT Biopharm, Cytoki Pharma, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, Gossamer Bio, GSK, HAC-Pharma, IAG Image Analysis, Index Pharmaceuticals, Inotrem, Janssen, Lilly, Medac, Mopac, Morphic, MSD, Norgine, Novartis, OM Pharma, ONO Pharma, OSE Immunotherapeutics, Pandion Therapeutics, Pfizer, Prometheus, Protagonist, Roche, Sandoz, Takeda, Theravance, Thermo Fisher, Tigenix, Tillots, Viatris, Vifor, Ysopia, Abivax; he received grants from Takeda, Fresenius Kabi, Celltrion; he served as a speaker for Galapagos, AbbVie, Janssen, Genentech, Ferring, Tillots, Celltrion, Takeda, Pfizer, Sandoz, Biogen, MSD, Amgen, Vifor, Arena, Lilly, Gilead, Viatris, Medac; he also declares support travel by Galapagos, AbbVie, Janssen, Genentech, Ferring, Tillots, Celltrion, Takeda, Pfizer, Gossamer Bio, Sandoz, MSD, Amgen, Lilly, Gilead, Thermo Fisher, Medac, CONNECT Biopharm; he declares stock options of Clinical Trials Mobile Application. S.D. has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma, and Vifor.

References