Colon to Rectum
United European Gastroenterol J. 2022;10(7):775–82
Ulcerative colitis: Impact of early disease clearance on long-term outcomes – A multicenter cohort study
Background: Clinical remission and endoscopic mucosal healing are the main treatment targets in patients with ulcerative colitis (UC). Recently, the concept of disease clearance has been proposed as a potential target in UC.
Objective: The authors aimed to evaluate the impact of disease clearance on long-term outcomes in UC patients.
Methods: A multicenter retrospective cohort study was conducted at the Humanitas Research Hospital-IRCCS (Italy) and at the Nancy University Hospital (France) between 2014 and 2021. Disease clearance in UC was defined as simultaneous clinical (partial-Mayo score ≤ 2), endoscopic (endoscopic-Mayo score = 0), and histological (Nancy index = 0) remission, and patients were monitored over a long-time follow-up (≥ 12 months), to compare the occurrence of negative outcomes.
Results: A total of 494 patients with UC were included in the study (269, 54.4% males). Disease clearance was present in 109 patients (22.1%) at baseline. Median follow-up was 24 months. Patients with disease clearance were associated to a significantly lower risk of UC-related hospitalization compared with the control group (5.5% vs. 23.1%; p < 0.001) at last observation. Similarly, a lower rate of surgeries was detected in patients with disease clearance at baseline compared with those without (1.8% vs. 10.9%; p = 0.003). The Kaplan-Meier curves confirmed that patients with disease clearance at baseline had a lower risk of hospitalization (log-rank p < 0.0001) and surgery (log-rank p < 0.00095).
Conclusion: In patients with ulcerative colitis with early disease clearance are at significant lower risk for hospitalization and surgery. Disease clearance should be considered as a new composite outcome.