Abstract
PurposeThe clinical course of ulcerative colitis (UC) is highly heterogeneous, with 20 to 30% of patients experiencing chronic disease activity requiring immunosuppressive or biologic therapies. The aim of this study was to identify predictors for a complicated disease course in an inception cohort of patients with UC.MethodsEPICOL was a prospective, observational, inception cohort (UC diagnosis, ≤ 6 months) study in 311 patients with UC who were naive to immunosuppressants (IS)/biologics. A complicated course of disease was defined as the need for IS and/or biologic treatment (here therapy with a TNF-α antagonist) and/or UC-related hospitalisation. Patients were followed up for 24 months.ResultsOf the 307 out of 311 participants (4 patients did not meet the inclusion criteria “confirmed diagnosis of active UC within the last 6 months” (n = 2) and “immunosuppressive-naïve” (n = 2), analysis population), 209 (68.1%) versus 98 (31.9%) had an uncomplicated versus a complicated disease course, respectively. In a multivariate regression analysis, prior use of corticosteroids and prior anaemia were associated with a significantly increased risk for a complicated disease course (2.3- and 1.9-fold increase, respectively; p < 0.001 and p = 0.002). Based on these parameters, a risk model for patient stratification was developed.ConclusionOur study identifies anaemia and an early need for corticosteroids as predictors for a complicated course of disease in an inception cohort of patients with UC. By determining these parameters in routine clinical practice, our results may support the identification of patients who might benefit from early escalation of therapy.
Highlights
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterised by colonic inflammation extending proximally from the rectum [1]
As with the forerunner study, EPIC, we aimed to prospectively validate numerous clinical predictors for a complicated disease course in patients recently diagnosed with UC, focusing in particular on parameters that are readily assessable in everyday clinical practice
EPICOL is a prospective study with the same design as the recently published EPIC (Early Predictive Parameters of Immunosuppressive Therapy in Crohn’s Disease) study, in which we investigated clinical parameters for their predictive power regarding the disease course in patients with recently diagnosed Crohn’s disease (CD) who were naive to treatment with both IS and biologics [24]
Summary
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterised by colonic inflammation extending proximally from the rectum [1]. UC may present as proctitis, left-sided colitis, or pancolitis [2]. International Journal of Colorectal Disease (2022) 37:485–493. Conventional management of UC is based on a step-up approach in which treatment is continually escalated if the therapeutic goals are not reached [5, 6]. Aminosalicylates, such as 5-aminosalicylic acid (5-ASA) with oral or rectal administration, are used as first-line medication, followed by oral or intravenous corticosteroid treatment if the disease remains uncontrolled. Patients with steroid dependency and frequent relapses can subsequently be treated with immunosuppressants (IS)/immunomodulators and advanced therapies, such as tumour necrosis factor–α (TNF-α) antagonists, anti-integrin antibodies, interleukin-12/23 antagonists, or Janus kinase inhibitors [5, 6]
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