Endoscopic score vs blood cell indices for determining timing of immunomodulator withdrawal in quiescent ulcerative colitis

Takenaka, Kazuhiro; Tominaga, Keiichi; Kanazawa, Mimari; Fukushi, Koh; Tanaka, Takanao; Kanamori, Akira; Sugaya, Takeshi; Tsuchida, Kouhei; Iijima, Makoto; Goda, Kenichi; Irisawa, Atsushi

doi:10.1038/s41598-019-54369-7

Cited by 7 publications

(4 citation statements)

References 47 publications

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“…Similarly, Cassinotti et al conducted a long-term survey in 155 patients with UC who discontinued AZA during the remission period and found relapse in one-third of patients after 1 year and in half of the patients after 2 years (Cassinotti et al, 2009). We have also previously demonstrated that the relapse rate is greater in the withdrawal group when comparing remission maintenance rates between thiopurine continuation and withdrawal groups of patients with UC with long-term sustained remission, and showed that endoscopic remission (Mayo endoscopic subscore 0) did not guarantee the absence of relapse after withdrawal (Takenaka et al, 2019). As described, a high relapse risk clearly exists with the withdrawal of thiopurines administered as remission maintenance therapy.…”

Section: Involvement Of Long-term Thiopurines and Onset Of Lymphoproliferative Disorders (Lpds)mentioning

confidence: 91%

Thiopurines: Recent Topics and Their Role in the Treatment of Inflammatory Bowel Diseases

et al. 2021

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Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory bowel diseases (IBD) of unknown etiology, characterized by repeated relapse and remission. The efficacy of thiopurine in IBD was first reported in the late 1960s. Thiopurines are used to alleviate the symptoms of IBD, especially UC. These drugs have a steroid-sparing potential and are widely used for the purpose of maintaining long-term remission in steroid-dependent cases. Therefore, thiopurines tend to be used long-term, but adverse events that accompany long-term use, such as lymphoproliferative disorders, must be monitored with care. In contrast, thiopurine plays a critical role in controlling the immunogenicity of biologics. Furthermore, although thiopurine is an old drug, new findings, including the prediction of serious adverse events such as severe alopecia and acute advanced leukopenia, by nudix hydrolase 15 gene polymorphism analysis, as well as the possibility of appropriate drug monitoring by detailed analysis of 6-thioguanine nucleotides have been clarified. However, the consequences of thiopurine withdrawal have not been determined and further studies, including randomized controlled trials, are necessary to answer the clinical question regarding the scenarios in which thiopurine withdrawal is possible.

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Section: Involvement Of Long-term Thiopurines and Onset Of Lymphoproliferative Disorders (Lpds)mentioning

confidence: 91%

Thiopurines: Recent Topics and Their Role in the Treatment of Inflammatory Bowel Diseases

et al. 2021

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“…Consistent with previous publications, we found statistically significant differences in faecal calprotectin concentrations according to endoscopic activity. We also examined other serum biomarkers to assess endoscopic activity in CED, but only CRP showed statistical significance, whereas other biomarkers were inappropriate for endoscopic activity [ 19 ]. CRP was used before to distinguish between quiescent and active disease, but in general, the correlation between CRP and endoscopic activity is lower than that between faecal markers and activity [ 12 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of faecal calprotectin in ulcerative colitis – single centre experience

Grgić

Golubić²,

Brinar

et al. 2022

Annals of Medicine

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Objectives Faecal calprotectin is an important biomarker used in the evaluation of inflammatory bowel disease. The aim of this study was to establish the value of faecal calprotectin concentration as a predictor of remission in ulcerative colitis and its correlation with laboratory, endoscopic and clinical findings. Methods The single centre study included 126 adult patients with established diagnosis of ulcerative colitis consecutively visiting our Day clinic from March 2017 to March 2019. We measured serum biomarkers- CRP, haemoglobin, leukocytes and platelets. Faecal calprotectin was determined from stool, and endoscopy was performed with calculation of MAYO endoscopic subscore system (MES 0–1: remission, and MES 2–3: active disease). Clinical assessment was done by using Mayo score for ulcerative colitis (clinical Mayo score <2:remission, >5: active disease).The statistical analysis was performed using an univariate and multivariate model of disease remission prediction using logistic regression. Results According to univariate analysis the increase of faecal calprotectin concentration by 10 ug/g is associated with an 8% decrease in probability of disease remission (OR 0.9921, p < .05). In the multivariate analysis, faecal calprotectin remained a significant predictor of disease remission (OR 0.9948, 95% CI 0.9914–0.9982, p = .0028), however, with a significant contribution of C-reactive protein (OR 0.8340, 95% CI 0.7085–0.9818, p = .0292). According to our model the cut off value for faecal calprotectin was 154 ug/g. Conclusion Our results have shown that faecal calprotectin is an independent predictor of remission in UC patients. The results of our study represent real-life data from a single university centre dealing with FC as a prognostic marker in patients with UC. KEY MESSAGES Faecal calprotectin is an independent predictor of remission in UC patients. Recent studies have suggested that calprotectin correlates well with endoscopic activity of inflammation but correlation of faecal calprotectin in a phase of remission hasn’t been evaluated yet. We have found that other inflammatory biomarkers do not correlate well with either endoscopic or clinical activity in ulcerative colitis.

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“…To date, all studies on the endoscopic severity of patients with UC have assigned a single MES score to a single endoscopic image. However, MES may often vary depending on the location in a single picture (Fig 3A -3C), especially in the resolution phase [7][8][9][32][33][34][35][36]. In addition, systematic disease severity along the length of the colorectum has been elusive because images are taken at undefined intervals during colonoscopy.…”

Section: Plos Onementioning

confidence: 99%

Automated evaluation of colon capsule endoscopic severity of ulcerative colitis using ResNet50

et al. 2022

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Capsule endoscopy has been widely used as a non-invasive diagnostic tool for small or large intestinal lesions. In recent years, automated lesion detection systems using machine learning have been devised. This study aimed to develop an automated system for capsule endoscopic severity in patients with ulcerative colitis along the entire length of the colon using ResNet50. Capsule endoscopy videos from patients with ulcerative colitis were collected prospectively. Each single examination video file was partitioned into four segments: the cecum and ascending colon, transverse colon, descending and sigmoid colon, and rectum. Fifty still pictures (576 × 576 pixels) were extracted from each partitioned video. A patch (128 × 128 pixels) was trimmed from the still picture at every 32-pixel-strides. A total of 739,021 patch images were manually classified into six categories: 0) Mayo endoscopic subscore (MES) 0, 1) MES1, 2) MES2, 3) MES3, 4) inadequate quality for evaluation, and 5) ileal mucosa. ResNet50, a deep learning framework, was trained using 483,644 datasets and validated using 255,377 independent datasets. In total, 31 capsule endoscopy videos from 22 patients were collected. The accuracy rates of the training and validation datasets were 0.992 and 0.973, respectively. An automated evaluation system for the capsule endoscopic severity of ulcerative colitis was developed. This could be a useful tool for assessing topographic disease activity, thus decreasing the burden of image interpretation on endoscopists.

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Endoscopic score vs blood cell indices for determining timing of immunomodulator withdrawal in quiescent ulcerative colitis

Cited by 7 publications

References 47 publications

Thiopurines: Recent Topics and Their Role in the Treatment of Inflammatory Bowel Diseases

Thiopurines: Recent Topics and Their Role in the Treatment of Inflammatory Bowel Diseases

Predictive value of faecal calprotectin in ulcerative colitis – single centre experience

Automated evaluation of colon capsule endoscopic severity of ulcerative colitis using ResNet50

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