Abstract
Background & Aims: Clinical remission, defined by a composite of patient reported outcomes and Mayo endoscopy subscore (MES) 0 or 1 is a recommended treatment target in patients with ulcerative colitis (UC). We estimated whether incorporating more rigorous remission definitions, of endoscopic remission (MES 0) and histologic remission, affects risk of relapse. Methods: Through a systematic review, we identified cohort studies in adults with UC in clinical remission that reported a minimum 12-month risk of clinical relapse, based on MES (0 vs 1) and/or histologic disease activity, in patients with endoscopic remission. Using random effects meta-analysis, we calculated relative and absolute risk of clinical relapse in patients with UC achieving different treatment targets. Results: In a meta-analysis of 17 studies that included 2608 patients with UC in clinical remission, compared to patients achieving MES 1, patients achieving MES 0 had a 52% lower risk of clinical relapse (relative risk, 0.48; 95% CI, 0.37–0.62). The median 12-month risk of clinical relapse in patients with MES 1 was 28.7%; the estimated annual risk of clinical relapse in patients with MES 0 was 13.7% (95% CI, 10.6–17.9). In a meta-analysis of 10 studies in patients in endoscopic remission (MES 0), patients who achieved histologic remission had a 63% lower risk of clinical relapse vs patients with persistent histologic activity (relative risk, 0.37; 95% CI, 0.24–0.56). Estimated annual risk of clinical relapse in who achieved achieving histologic remission was 5.0% (95% CI, 3.3–7.7). CONCLUSIONS: In a systematic review and meta-analysis of patients with UC in clinical remission, we observed that patients achieving more rigorous treatment endpoints (endoscopic and histologic remission) have a substantially lower risk of clinical relapse compared with patients achieving clinical remission.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1262-1275.e7 |
| Journal | Gastroenterology |
| Volume | 159 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 2020 |
Funding
Funding Parambir S. Dulai is supported by an American Gastroenterology Association Research Scholar Award. William Sandborn is supported by the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases-funded San Diego Digestive Diseases Research Center (P30-DK-120515). Siddharth Singh is supported by an American College of Gastroenterology Junior Faculty Development Award #144271, Crohn’s and Colitis Foundation Career Development Award #404614, and the National Institute of Diabetes and Digestive and Kidney Diseases K23-DK-117058. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Parambir S. Dulai is supported by an American Gastroenterology Association Research Scholar Award. William Sandborn is supported by the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases-funded San Diego Digestive Diseases Research Center (P30-DK-120515). Siddharth Singh is supported by an American College of Gastroenterology Junior Faculty Development Award #144271, Crohn's and Colitis Foundation Career Development Award #404614, and the National Institute of Diabetes and Digestive and Kidney Diseases K23-DK-117058. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Keywords
- Abdominal Pain
- Biopsy
- IBD
- Inflammation
- Inflammatory Bowel Disease
- Treat-to-Target
ASJC Scopus subject areas
- Hepatology
- Gastroenterology