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Treating to target achieved mucosal healing for UC patients
Endoscopically guided treatments repeatedly adjusted to achieve mucosal healing represented an effective, novel approach for patients with ulcerative colitis in a recent study.
“These findings clearly demonstrate that it is possible to achieve high rates of mucosal healing [MH] at colonoscopy by doing serial endoscopic procedures and adjusting therapy when mucosal healing was not achieved,” researcher William J. Sandborn, MD, director at the University of California, San Diego, IBD Center, told Healio.com.
Sandborn and colleagues reviewed and included medical records from 60 ulcerative colitis (UC) patients (median age, 37 years; 32 women) who had undergone at least two endoscopic procedures between 2011 and 2012. Incidence of MH and histologic healing (HH) was estimated using a Kaplan–Meier method, and researchers sought to determine the feasibility of “treating to target” based on endoscopic evidence of reaching MH.
William J. Sandborn
Data indicated that patients showed active endoscopic and histologic disease in 45 and 48 cases, respectively. Sixty percent of patients with endoscopic disease activity at baseline reached MH at a median of 76 weeks of follow-up, while 50% of those displaying histologic disease achieved HH.
Researchers determined the cumulative probabilities of MH compared with HH at 26, 52 and 76 weeks from the initial endoscopic procedure as 26% vs. 19%, 52% vs. 41%, and 70% vs. 57%, respectively. Fifty-one adjustments to medical therapy, during up to five cycles of measurement, were made among the 45 patients with endoscopic disease during follow-up. These adjustments for persistent disease were associated with improvement in MH (HR=9.8; 95% CI, 3.6-34.5) and HH (HR=9.2; 95% CI, 3.4-31.9).
“This treatment strategy, called treating to target, now needs to be prospectively analyzed in a randomized trial to demonstrate that treating to the target of mucosal healing leads to superior clinical outcomes as compared with treating to clinical outcomes,” Sandborn said.
— Matthew Galella
Disclosure: See the study for a full list of relevant financial disclosures.