Endoscopic, histologic remission come with lower relapse risk in UC
Patients with ulcerative colitis who achieve more rigorous treatment endpoints are at lower risk for relapse than patients who only achieve clinical remission, according to study results.
Siddarth Singh, MD, MS, of the division of gastroenterology at the University of California, San Diego, and colleagues wrote that clinical remission based on a Mayo endoscopic subscore (MES) of 0 or 1 and patient-reported outcomes has long served as a clinical target and primary endpoint for clinical trials in UC.
“Multiple observational studies have suggested that patients with UC who achieve endoscopic remission (MES 0) and/or histologic remission may have a lower risk of clinical relapse and disease-related complications than those who achieve conventionally defined remission,” they wrote. “In addition, the notion of mucosal healing has been evolved from an endoscopic-based definition to a composite of endoscopy and histopathology.”
Investigators searched the literature for studies in adults with UC in clinical remission that reported a minimum 12-month risk for clinical relapse, based on MES (0 vs. 1) and histologic disease activity. They determined relative and absolute risk for clinical relapse in patients who achieved different treatment targets.
Researchers identified 17 studies comprising 2,608 patients that fit their criteria.
Compared with patients who achieved MES 1, patients who achieved MES 0 had a 52% lower risk for clinical relapse (relative risk [RR] = 0.48; 95% CI, 0.37-0.62). The median 12-month risk for clinical relapse in patients with MES 1 was 28.7% while the estimated annual risk for clinical relapse in patients with MES 0 was 13.7% (95% CI, 10.6-17.9).
In their analysis of 10 studies of patients in endoscopic remission, researchers found that patients who achieved histologic remission had a 63% lower risk for clinical relapse vs. patients with persistent histologic activity (RR = 0.37; 95% CI, 0.24-0.56). The estimated annual risk for clinical relapse in patients who achieved histologic remission was 5% (95% CI, 3.3-7.7).
Singh and colleagues wrote their findings suggest that more strenuous treatment targets help lower the risk for relapse among patients with UC.
“These end points may be considered as preferred treatment targets, but future studies are needed to evaluate the population-level feasibility and cost effectiveness of treating patients with UC to these end points,” they wrote.