Should we Target Complete Endoscopic Healing in Patients with Acute Severe Ulcerative Colitis?

Abstract

Achieving endoscopic healing is a recommended target in ulcerative colitis [UC]. However, little is known about desirable goals in patients with acute severe UC [ASUC]. Taking advantage of the long-term follow-up of clinical trial patients with steroid-refractory ASUC, the present analysis aimed to quantify the observed association between the Mayo endoscopic sub-score [MES], 0 or 1, at clinical trial end and patients' long-term disease outcome. Patients in the prospective CYSIF clinical trial were included in the present analysis if they had achieved steroid-free clinical remission with an MES of 0 or 1 at the end of the trial, at day 98. Events during long-term follow-up had been retrospectively collected. The primary endpoint for this complementary analysis was the occurrence of an event, death or disease relapse [defined by recurrence of symptoms with need for a new systemic treatment or colectomy]. Forty-four patients were included in the present analysis. When censoring follow-up at 5 years, six and nine events were observed among 26 and 18 patients having an MES of 0 and 1, respectively. Survival without disease relapse at 1, 2 and 5 years was respectively 88 ± 6, 81 ± 8 and 77 ± 8% in patients with MES of 0, and 72 ± 11, 53 ± 12 and 46 ± 12% in those with MES of 1 [hazard ratio: 2.8; 95% confidence interval: 1.0-8.0; p = 0.042]. In a cohort of patients admitted for ASUC in whom clinical and endoscopic healing has been achieved with a second-line medical therapy, better survival without disease relapse was observed with complete endoscopic healing.