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

Abstract

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.