Relapse risk doubles in UC patients with histologic inflammation
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SAN DIEGO — Among ulcerative colitis patients in endoscopic remission, histologic inflammation increased the risk for loss of remission, according to a presentation at Digestive Disease Week 2022.
“In this large, multicenter, real-world study including both academic and community practices using standard-of-care reports, histologic inflammation — despite endoscopic remission — independently conveyed a two-fold increased risk for subsequent relapse within a year,” Benjamin Click, MD, MS, assistant professor at the University of Colorado Crohn’s and Colitis Center and School of Medicine, told Healio.
Click and colleagues conducted a real-world analysis of 513 corticosteroid-free, adult UC patients (53% women; median disease duration, 10 years) enrolled in Target-IBD, all of whom were in endoscopic remission on index colonoscopy and had an index histology assessment.
Investigators defined loss of remission as presence of endoscopic inflammation, erosion or ulceration on follow-up colonoscopy or steroid commencement and follow-up time as days from index colonoscopy to loss of remission, death, discontinuation from study, IBD surgery or the end of available data.
During follow-up, 188 patients experienced loss of remission, with a median time to relapse of 11.8 months. Among these patients, the median follow-up time was 21.3 months.
Results further showed that histological inflammation on index biopsy correlated with a greater risk for loss of remission (HR = 2.01; 95% CI, 1.5-2.69) compared with patients with histologically quiescent disease. Conversely, older age correlated with a lower risk for loss of remission (HR = 0.988; 95% CI, 0.978-0.998).
Click and colleagues did not modify results related to inflammation on index biopsy based on disease location, current biologic use or the number of previous biologics.
“This study validates prior findings from academic centers demonstrating that histologic activity identifies a higher risk remission population in UC,” Click said. “Future research should examine whether treatment changes or enhanced monitoring based on this finding can prevent subsequent loss of remission.”
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Click B, et al. Poster Su1537. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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