964 Agreement Between Deep Histological Remission and Mucosal Healing in Ulcerative Colitis and Predictors of Each Outcome

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BACKGROUND: In patients with ulcerative colitis (UC), mucosal healing (MH) has emerged as a new therapeutic goal to prevent long-term complications. However a few small studies have demonstrated that MH may not always be an accurate indicator of histologic remission (HR). Presence of persistent microscopic inflammation may predict a higher risk of both colectomy and hospitalization in patients with UC and is associated with an increased risk of colorectal neoplasia. HR is therefore increasingly considered as an end-point in clinical trials. The aim of this study was to examine both the prevalence and possible predictors of MH, HR and MH without HR in patients with confirmed UC. METHODS: Patients with confirmed UC who had a baseline colonoscopy with biopsies taken in each segment of the colon (rectum, left-side and right-side) and had a follow-up colonoscopy more than one year later were identified. Each colonic segment of the final colonoscopy was evaluated retrospectively for MH as defined by the description of a normal mucosa or endoscopic quiescent inflammation and HR as defined by absence of residual histological inflammation. Demographic, clinical, histological and biochemical data were collected from case records. The primary outcome was MH, HR and MH without HR. Variables influencing HR, MH and MH without HR were examined using the chi-square test, Wilcoxon rank-sum test and logistic regression. RESULTS: 646 patients were identified; 60.0% had MH and 50.3% had HR. (Table 1) MH was strongly associated with HR (OR 13.41, 95%CI [7.137, 26.128], p<0.001). On multivariate analysis longer duration of disease (p=0.004), current therapy with an anti-TNF treatment (p=0.019), current therapy with an anti-metabolite (p=0.037) and C-reactive protein less than 3.0 (p=0.002) predictedMH. Predictors of HR onmultivariate analysis were longer duration of disease (p=0.003), current therapy with an anti-TNF (p= 0.005), current therapy with an anti-metabolite (p=0.012), past therapy with steroids (p= 0.011) and C-reactive protein less than 3.0 (p<0.001). Of the 385 patients who had MH, 80 patients (20.8%) were found to have ongoing histological activity. On multivariate analysis only C-reactive protein more than 2.9 predicted ongoing histological activity in those with MH (AOR 3.56, 95%CI [1.55-8.16], p=0.003). CONCLUSION: MH is strongly associated with HR however 20.8% of patients with MH have evidence of histological activity on biopsy. C-reactive protein greater than 2.9 independently predicts ongoing histological activity in the presence of complete MH. These findings have considerable significance for evolving endpoints of management. Table 1: Baseline Characteristics