Predictors and outcomes of histological remission in ulcerative colitis treated to endoscopic healing

Abstract

Summary Background Clinical remission is the recommended treatment target in ulcerative colitis. The predictors and outcomes of achieving histologic remission within a treat‐to‐target paradigm are not well established. Aim To evaluate the predictors and outcomes of achieving histologic remission in patients with ulcerative colitis treated‐to‐target of endoscopic healing (modified Mayo endoscopy score 0 or 1). Methods We conducted a retrospective cohort study in adults with active ulcerative colitis (modified Mayo endoscopy score 2 or 3), whose treatment was iteratively optimised to achieve endoscopic healing. We identified predictors of achieving histologic remission, and outcomes (risk of symptomatic relapse, and ulcerative colitis‐related hospitalisation and/or surgery) of achieving histologic remission vs persistent histologic activity, using Cox proportional hazard analysis. Results Of the 411 patients with clinically active ulcerative colitis, 270 achieved endoscopic healing. Of the 270 patients, 55% simultaneously achieved histologic remission. Depth of endoscopic healing at final endoscopic assessment was the only independent determinant of histologic remission (modified Mayo endoscopy score 0 vs 1: odds ratio, 0.31 [95% confidence intervals, 0.18‐0.52]). Over 28 months, achieving histologic remission was associated with a lower risk of clinical relapse (1‐year cumulative risk: 18.7% vs 29.5%; adjusted hazard ratio, 0.56 [0.37‐0.85]), and lower risk of hospitalisation (hazard ratio, 0.44 [0.20‐0.94]). The incremental benefit of achieving histologic remission was observed only in patients achieving Mayo endoscopy score 1, but not Mayo endoscopy score 0. Conclusions In patients with active ulcerative colitis treated‐to‐target of endoscopic healing, 55% simultaneously achieved histologic remission. Histologic remission, particularly in patients achieving modified Mayo endoscopy score 1, was associated with favourable outcomes. Treating to a target of histologic remission over endoscopic healing requires prospective evaluation.

Letter: the combination of histologic remission and Mayo endoscopic score 1 as a suitable therapeutic target in ulcerative colitis—authors' reply

“…In our cohort, we suggested that histologic remission only has benefit in patients with MES = 1 disease, with no further benefit noted in patients who attain MES = 0 disease 2 . Our findings do not conflict with Maeda et al, but support that achievement of histologic remission in MES = 1 endoscopic disease provides benefit over and above attaining MES = 1 disease alone.…”

“…The authors' declarations of personal and financial interests are unchanged from those in the original article. 2…”

“…In our cohort, we suggested that histologic remission only has benefit in patients with MES = 1 disease, with no further benefit noted in patients who attain MES = 0 disease. 2…”

Letter: the combination of histologic remission and Mayo endoscopic score 1 as a suitable therapeutic target in ulcerative colitis

“…We read with great interest the article by Jangi et al who reported that histologic remission was associated with favourable outcomes in patients with a Mayo endoscopic subscore (MES) of 1 1 . The article provided useful information for setting the treatment target in ulcerative colitis (UC); however, we would like to ask the authors whether they conducted a direct comparison of the cumulative risks of symptomatic relapse between patients achieving both histologic remission and MES = 1 and those with MES = 0.…”

Analysis of Endoscopic Evaluation Reliability for Ulcerative Colitis in Histological Remission

“…As described above, different studies have positively evaluated the validity and reliability of the endoscopic criteria that are commonly used for UC today. However, in several cases, ER was observed without full achievement of histological remission [14][15][16]. Some reports describe that the histological activity and endoscopic activity are correlated [17,18] but endoscopic findings with a low activity must be assessed for patients who have achieved histological remission.…”