Dataset Information

Ulcerative colitis: Impact of early disease clearance on long-term outcomes - A multicenter cohort study.

ABSTRACT:

Background

Clinical remission and endoscopic mucosal healing are the main treatment targets in patients with ulcerative colitis (UC). Recently, the concept of disease clearance has been proposed as a potential target in UC.

Objective

We aimed to evaluate the impact of disease clearance on long-term outcomes in UC patients.

Methods

A multicenter retrospective cohort study was conducted at the Humanitas Research Hospital-IRCCS (Italy) and at the Nancy University Hospital (France) between 2014 and 2021. Disease clearance in UC was defined as simultaneous clinical (partial-Mayo score ≤2), endoscopic (endoscopic-Mayo score = 0), and histological (Nancy index = 0) remission, and patients were monitored over a long-time follow-up (≥12 months), to compare the occurrence of negative outcomes.

Results

A total of 494 patients with UC was included in the study (269, 54.4% males). Disease clearance was present in 109 patients (22.1%) at baseline. Median follow up was 24 months. Patients with disease clearance were associated to a significantly lower risk of UC-related hospitalization compared with the control group (5.5% vs. 23.1%; p < 0.001) at last observation. Similarly, a lower rate of surgeries was detected in patients with disease clearance at baseline compared with those without (1.8% vs. 10.9%; p = 0.003). The Kaplan Meier curves confirmed that patients with disease clearance at baseline had a lower risk of hospitalization (log-rank p < 0.0001) and surgery (log-rank p < 0.00095).

Conclusion

In UC patients with early disease clearance are at significant lower risk for hospitalization and surgery. Disease clearance should be considered as a new composite outcome.

SUBMITTER: D'Amico F

PROVIDER: S-EPMC9486490 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Ulcerative colitis: Impact of early disease clearance on long-term outcomes - A multicenter cohort study.

D'Amico Ferdinando F Fiorino Gionata G Solitano Virginia V Massarini Eugenia E Guillo Lucas L Allocca Mariangela M Furfaro Federica F Zilli Alessandra A Bonovas Stefanos S Magro Fernando F Peyrin-Biroulet Laurent L Danese Silvio S

United European gastroenterology journal 20220915 7

<h4>Background</h4>Clinical remission and endoscopic mucosal healing are the main treatment targets in patients with ulcerative colitis (UC). Recently, the concept of disease clearance has been proposed as a potential target in UC.<h4>Objective</h4>We aimed to evaluate the impact of disease clearance on long-term outcomes in UC patients.<h4>Methods</h4>A multicenter retrospective cohort study was conducted at the Humanitas Research Hospital-IRCCS (Italy) and at the Nancy University Hospital (Fra ...[more]

PMID: 36107109

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Project description:Background & aimsIn patients with acute severe ulcerative colitis (ASUC), standard infliximab induction therapy has modest efficacy. There are limited data on the short-term or long-term efficacy of accelerated infliximab induction therapy for these patients.MethodsIn a retrospective study, we collected data from 213 patients with steroid refractory ASUC who received infliximab rescue therapy at 3 centers, from 2005 through 2017. Patients were classified that received standard therapy (5mg/kg infliximab at weeks 0, 2, and 6) or accelerated therapy (>5mg/kg infliximab at shorter intervals). The primary outcome was colectomy in-hospital and at 3, 6, 12, and 24 months. Multivariable regression models were adjusted for relevant confounders. We also performed a meta-analysis of published effects of standard vs accelerated infliximab treatment of ASUC.ResultsIn the retrospective analysis, 81 patients received accelerated infliximab therapy and 132 received standard infliximab therapy. There were no differences in characteristics between the groups, including levels of C-reactive protein or albumin. Similar proportions of patients in each group underwent in-hospital colectomy (9% receiving accelerated therapy vs 8% receiving standard therapy; adjusted odds ratio, 1.35; 95% CI, 0.38-4.82). There was no significant difference between groups in proportions that underwent colectomy at 3, 6, 12, or 24 months (P > .20 for all comparisons). Among those in the accelerated group, an initial dose of 10 mg/kg was associated with a lower rate of colectomy compared to patients who initially received 5 mg/kg followed by subsequent doses of 5mg/kg or higher. Our systematic review identified 7 studies (181 patients receiving accelerated infliximab and 436 receiving standard infliximab) and found no significant differences in short- or long-term outcomes.ConclusionIn a retrospective study and meta-analysis, we found no association between accelerated infliximab induction therapy and lower rates of colectomy in patients with ASUC, compared to standard induction therapy. However, confounding by disease severity cannot be excluded. Randomized trials are warranted to compare these treatment strategies.

Dataset Information

Ulcerative colitis: Impact of early disease clearance on long-term outcomes - A multicenter cohort study.

Background

Objective

Methods

Results

Conclusion

Publications

Ulcerative colitis: Impact of early disease clearance on long-term outcomes - A multicenter cohort study.

Similar Datasets

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