The major objective of this research was to assess the percentage of children with Crohn’s disease (CD) who remain in drug-free remission 52 weeks after treatment discontinuation. Researchers also hoped to learn more about how the Crohn’s Disease Exclusion Diet (CDED) and the make-up of the microbiota influence healing. They conducted prospective research at 2 tertiary care facilities, monitoring 18 CD patients ages 13-21 who had achieved deep clinical remission while on immunomodulator (n=7) or anti-TNFα(n=11) monotherapy and were planning to discontinue treatment. Over the course of 52 weeks, samples of stool were collected for calprotectin and microbiota testing. After completing drug withdrawal, participants either followed the CDED or a free diet. The major outcome measure was 52 weeks of treatment-free remission without relapse (calprotectin <250µg/g).

After 52 weeks of observation, 11 patients (64.7% of the total) were still in remission. The CDED did not lead to a significant increase in remission among study participants (5/9; 55.6%); P equals 0.63. About  (47.1%) of the original subjects were still drug-free after 104 weeks. By analyzing shotgun metagenomic sequencing data, researchers found that the gut microbiome’s taxonomic and gene function abundance remained consistent between those in remission and those in relapse. Relapse could be predicted at 52 weeks with 80% accuracy using baseline samples and the number of genes involved in amino sugar/nucleotide sugar metabolism and galactose metabolism in the gut microbiota.

A small cohort of children with CD in deep remission showed that over 65% of those who discontinued immunomodulator or anti-TNFα treatment were still in remission 52 weeks later. Changing the microbiota at the beginning of treatment was a good predictor of relapse. Large prospective studies must be conducted to better comprehend the results following treatment de-escalation.