Clinical Remission as Defined by the Mayo Score

Abstract

Reply: In his comment on our article, Professor Peyrin-Biroulet raises an important point and astutely identifies some of the deficiencies of the Mayo score and inconsistencies in its use. We agree with his assertion that combining clinical and endoscopic parameters into a single index is inherently flawed. We also agree that we should be moving away from this dogmatic method of evaluating disease activity in ulcerative colitis as this type of approach increases the variability of evaluations and decreases statistical efficiency. It is also not fully validated and infrequently applied in clinical practice. However, we disagree regarding the possible solution to this problem suggested by Professor Peyrin-Biroulet. Instead of simply dividing the clinical and endoscopic Mayo components to derive additional unvalidated definitions for remission, we would be in favor of using patient-reported outcomes and endoscopy as co-endpoints. In our opinion, this approach offers several advantages. Primarily, by the nature of their generation, patient-reported outcomes can be considered more clinically meaningful than a physicians’ subjective symptom assessment as they are created and defined by patients themselves. This means that they are more readily applicable to clinical practice and, in combination with endoscopy as an objective measure of inflammation, offer the opportunity to remedy the existing disconnect in outcome assessment between trials and practice. The benefit of such convergence in goal-setting and progress evaluation is likely to grow as “treatto-target” algorithms becoming more widely adopted. When considering the most appropriate endoscopic instrument to use as a co-endpoint along side patient-reported outcomes, the systematic development and initial validation of the Ulcerative Colitis Endoscopic Index of Severity mean that it is ideally placed for this use. However, as described in our article, this would require further validation and growing adoption for routine use in clinical practice before it can be favored over the Mayo score.