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We read with great interest the study conducted by Gui et al,1 which developed a simplified histologic score (PICaSSO Histologic Remission Index (PHRI)) that only considers the presence of neutrophils in the epithelium and lamina propria.1 Many definitions of histologic remission (HR) have been proposed,2 3 and the absence of neutrophilic infiltration plays a key role in HR.4 5 In a post-hoc analysis of the VARSITY trial (NCT02497469),6 we observed that early changes in epithelial neutrophil involvement performed the best for predicting 1-year mucosal healing (MH) (area under the curve (AUC): 0.83, 95% CI 0.74 to 0.91) and histo-endoscopic mucosal improvement (HEMI) (AUC: 0.85, 95% CI: 0.76 to 0.94).7 Multivariate analyses demonstrated that improvement or lack thereof of epithelial neutrophilic infiltration was the only histologic component associated with 1-year MH and HEMI.
The sole reliance on neutrophilic infiltration as an indicator of HR is an appealing option given its simplicity. However, the question remains how accurately this captures true histologic disease activity. To validate this novel score, we performed a post-hoc analysis of 573 patients with 1-year …
Contributors ECLW: study concept and design; acquisition and compilation of data; statistical analysis; and drafting of the manuscript. PSD: data interpretation and drafting of the manuscript. NN: study concept and design; acquisition and compilation of data; statistical analysis; data interpretation; and drafting of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PSD has received consulting and/or research support from Takeda, Pfizer, Janssen, BMS, Gilead, Novartis and Lily, stock options from DigbiHealth and royalty from PreciDiag. NN holds a McMaster University's Department of Medicine Internal Career Award and has received honoraria from Janssen, Abbvie, Takeda, Pfizer, Merck, Sandoz, Novartis and Ferring.
Provenance and peer review Not commissioned; internally peer reviewed.
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