Endoscopic and histologic response to cyclosporine in ulcerative colitis and their impact on disease outcome: A cohort study

The Nancy Index and the Robarts Histopathology Index have undergone the most validation in that four operating properties including reliability, content validity, construct validity (hypothesis testing) and criterion validity have been tested. However, none of the currently available histologic scoring indices have been fully validated. In order to determine the optimal endpoint for histologic healing in UC, more research is required. The optimal index would need to be fully validated.

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Histologic scoring indices for evaluation of disease activity in ulcerative colitis

Mosli

Parker

Nelson

et al. 2017

Cochrane Database of Systematic Reviews

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Should we Target Complete Endoscopic Healing in Patients with Acute Severe Ulcerative Colitis?

Laharie

Mary

2023

Journal of Crohn's and Colitis

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Background Achieving endoscopic healing is a recommended target in ulcerative colitis (UC). However, little is known about the desirable goal in patients with acute severe UC (ASUC) episode. Taking the advantage of the long-term follow-up of clinical trial patients with steroid refractory ASUC, the present analysis aimed to quantify the observed association between the Mayo endoscopic sub-score (MES), 0 or 1, at clinical trial end and patient long-term disease outcome. Methods Patients in the prospective CYSIF clinical trial were included in the present analysis if they had achieved steroid-free clinical remission with a MES of 0 or 1 at the end of the trial, at day 98. Events during long-term follow-up had been retrospectively collected. Primary endpoint for this complementary analysis was the occurrence of an event, death or disease relapse (defined by recurrence of symptoms with need for a new systemic treatment or colectomy). Results Forty-four patients were included into the present analysis. When censoring follow-up at 5 years, 6 and 9 events were observed among 26 and 18 patients having MES of 0 and 1, respectively. Survival without disease relapse at 1, 2 and 5 years were respectively 88±6%, 81±8% and 77±8% in patients with MES of 0 and, 72±11%, 53±12% and 46±12% in those with MES of 1 (HR: 2.8; 95%CI: 1.0-8.0; p=0.042). Conclusion In a cohort of patients admitted for ASUC in whom clinical and endoscopic healing has been achieved with a second-line medical therapy, better survival without disease relapse was observed with complete endoscopic healing.

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Factors Associated With Response to Rescue Therapy in Acute Severe Ulcerative Colitis

Li Wai Suen,

Seah,

Choy

et al. 2023

Inflammatory Bowel Diseases

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Background Acute severe ulcerative colitis (ASUC) is a medical emergency for which colectomy is required in patients who do not respond to rescue therapy. While previous studies have predominantly focused on predicting outcome to first-line corticosteroid therapy, there is a need to understand the factors associated with response to rescue therapies in order to improve clinical outcomes. We reviewed the evidence regarding factors associated with response to rescue therapy in adults with ASUC and identified future directions for research. Methods A systematic search of the literature was conducted, and 2 reviewers independently assessed studies for inclusion. Results Of 3509 records screened, 101 completed studies were eligible for inclusion. We identified 42 clinical, hematological, biochemical, endoscopic, or pharmacological factors associated with response to rescue therapy. Older age (≥50 years), thiopurine experience, and cytomegalovirus or Clostridioides difficile infection were associated with a higher risk of nonresponse to rescue therapy. Biochemical factors associated with poorer response included an elevated C-reactive protein (CRP) ≥30mg/L on admission, hypoalbuminemia and an elevated ratio of CRP to albumin. Severe endoscopic findings, including a Mayo endoscopic score of 3 or Ulcerative Colitis Endoscopic Index of Severity ≥5, portended poorer outcomes. The role of fecal calprotectin and therapeutic value of measuring infliximab drug levels in ASUC remain to be defined. Conclusions Response to rescue therapy can be predicted by several specific factors, which would aid clinical decision-making. Existing and emerging factors should be integrated within predictive and prognostic models to help improve clinical outcomes.

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Endoscopic and histologic response to cyclosporine in ulcerative colitis and their impact on disease outcome: A cohort study

Cited by 3 publications

References 30 publications

Histologic scoring indices for evaluation of disease activity in ulcerative colitis

Histologic scoring indices for evaluation of disease activity in ulcerative colitis

Should we Target Complete Endoscopic Healing in Patients with Acute Severe Ulcerative Colitis?

Factors Associated With Response to Rescue Therapy in Acute Severe Ulcerative Colitis

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