Abstract

While immunomodulators (IMs) are used as key drugs in remission maintenance treatment for ulcerative colitis (UC), there has been no evidence to date for determining monitoring methods and drug withdrawal. Therefore, we examined if a decrease in white blood cell count (WBC) and an elevation in mean cell volume (MCV) could be used as optimization indices and if mucosal healing (MH) could be a rationale for determining the time of IM withdrawal. Subjects were 89 UC patients who were using IMs and for whom clinical remission had been maintained. Those with a Rachmilewitz Clinical Activity Index score of 4 or lower and those with a Mayo endoscopic subscore (MES) of 0 or 1 were defined as MH. The remission maintenance rates of the following comparative groups were examined: an IM continuation group and an IM withdrawal group; an IM continuation group with a WBC of less than 3000 or a MCV of 100 or greater and an IM continuation group with a WBC of 3000 or greater and a MCV of 99 or lower; an IM continuation group of patients for whom MH had been achieved and an IM continuation group of patients for whom MH had not been achieved; and an IM withdrawal group with a MES of 0 and an IM withdrawal group with a MES of 1. A significantly higher remission maintenance rate was observed in the IM continuation group compared to the withdrawal group (p < 0.01). No significant difference was observed between the IM continuation group with a WBC of less than 3000 or a MCV of 100 or greater and the IM continuation group with a WBC of 3000 or greater and a MCV of 99 or lower (p = 0.08). Higher remission maintenance rates were observed in the IM continuation group of patients for whom MH had been achieved compared to the IM continuation group of patients for whom MH had not been achieved (p = 0.03). No significant difference was observed between the IM withdrawal group with MES 0 and the IM withdrawal group with MES 1. (p = 0.48). This retrospective study showed that remission maintenance could be firmly obtained by continuing IM administration in case of endoscopic MH; however, MH was not an indicator of IM withdrawal.

Highlights

  • While immunomodulators (IMs) are used as key drugs in remission maintenance treatment for ulcerative colitis (UC), there has been no evidence to date for determining monitoring methods and drug withdrawal

  • Attention needs to be paid to genetic hair loss, severe myelosuppression, dose- and metabolism-dependent hepatic dysfunction, nausea and fatigue, lymphoproliferative disease resulting from long-term administration, and nonmelanoma skin cancer (NMSC)[21,22,23,24]

  • There have been reports on an investigation into the selection of treatment methods based on endoscopic monitoring for a case of Crohn’s disease (CD) requiring surgical treatment, and an investigation into the dose reduction of 5-aminosalicylic acid (5-ASA) preparations due to endoscopic mucosal healing (MH)

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Summary

Introduction

While immunomodulators (IMs) are used as key drugs in remission maintenance treatment for ulcerative colitis (UC), there has been no evidence to date for determining monitoring methods and drug withdrawal. There have been reports on an investigation into the selection of treatment methods based on endoscopic monitoring for a case of Crohn’s disease (CD) requiring surgical treatment, and an investigation into the dose reduction of 5-aminosalicylic acid (5-ASA) preparations due to endoscopic mucosal healing (MH). Many of these reports suggested that achieving MH is the goal of IBD treatment and that the degree of MH can be an index for selecting a treatment method[12,27,28,29]. The aim of the present study was to examine if MH, which is currently considered the goal of UC treatment, can be a rationale for IM withdrawal in UC cases where long-term remission has been achieved

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