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PREDICTORS OF ENDOSCOPIC AND HISTOLOGIC RESPONSE AFTER FIRST-LINE BIOLOGIC THERAPY IN ULCERATIVE COLITIS

KIJAE JO 1, Chan Hyung Lee 1, Hyun Jung Lee 1, Jong Pil Im 1, BYEONG GWAN KIM 1, Joo Sung Kim 1, Seong-Joon Koh 1

Affiliations

1 Seoul National University Hospital, Seoul, Korea, Republic of

Summary

AI Generated

A retrospective study of 72 ulcerative colitis patients receiving first-line biologics found that lower disease activity at baseline, measured by Mayo score, predicted both endoscopic and histological response to treatment.

In multivariate analysis, baseline Mayo score (odds ratio 0.796, p=0.046), ESR (odds ratio 1.051, p=0.007), and albumin (odds ratio 3.319, p=0.049) were significant predictors of treatment response.
Patients who achieved histological response had significantly lower baseline Mayo scores (6.0 versus 7.2) and higher albumin levels (4.06 versus 3.88) compared to the overall cohort.
The study included 72 patients treated with infliximab (46.7%), adalimumab (22.7%), or vedolizumab (21.3%) as first-line biologics, with no difference in histological response rates between agents.
The authors suggest that early escalation to biologics before disease worsens may improve prognosis, based on the finding that lower baseline disease activity predicted better histological and endoscopic outcomes.
This retrospective analysis may inform clinicians caring for ulcerative colitis patients considering first-line biologic therapy.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Ulcerative colitis (UC) is increasing in prevalence and incidence in Korea, and each patient shows a different course and treatment response. Since the 2000s, biologics have been developed and treatment options have diversified. Biologics and small-molecule therapeutics for immunological targets are currently under research and development. In the past, the goal was clinical improvement, including symptoms, but now endoscopic mucosal healing and, furthermore, the continuation of histological remission are gradually suggested. Accordingly, the purpose of this study was to identify clinical factors that could predict histological remission in patients receiving a first-line biologic agent, as well as confirm the patient's response to treatment and prognosis.

Aims & Methods

We retrospectively analyzed the medical records of 440 patients who had been diagnosed with UC and exposed to biologics for the first time in our hospital without using biologics at other hospitals between January 01, 2010 and December 31, 2022. Patients who did not undergo pre- and post-exposure endoscopy and biopsy or whose follow-up was discontinued were excluded. Clinical characteristics, blood tests, endoscopic findings, and pathological examination results of a total of 72 patients were collected. Endoscopic response was defined as a decrease in the Mayo Endoscopic Subscore (MES) compared to the score before the first exposure to the biological agent. Histological remission was defined as the result of no cryptitis, no crypt abscess, or no inflammatory cells observed on histological examination, and histological response was defined as remission in patients previously observed with active inflammation.

Results

The ratio of males to females was 53:19, and the median age at the time of diagnosis was 41 years. The average Mayo score at the time of diagnosis was 7.2, and the group with a histological response was 6.0, showing a statistically significant difference. The average albumin was 3.88 and was 4.06 in the histological response group, with a statistically significant difference. The median time to exposure to the first biologic was 1520 days. A colectomy was performed in three cases. Biologics were started with infliximab in 46.7% of patients, followed by adalimumab and vedolizumab in 22.7% and 21.3%, respectively. There was no statistical correlation between histological response and each biologic agent.
MES before exposure to biological agents was 50% in 2 and 44.4% in 3, but there was no statistical difference between each group. Multivariate logistic regression analysis was performed to identify predictors of endoscopic and histological responses after the first exposure to biological agents. As a result, it was confirmed that the Mayo score, ESR, and albumin had a causal relationship with the endoscopic response, respectively, and the odds ratio was 0.781, 1.051, and 3.319, respectively (p-value 0.044, 0.007, 0.049). In addition, it was confirmed that the Mayo score had a causal relationship with the histological response with an odds ratio of 0.796 (p-value 0.046).

Conclusion

This study confirmed that disease activity before treatment was a predictor of histological remission in UC patients using first-line biologics. It was confirmed that the histological response as well as the endoscopic response were well induced when the disease activity was low. Therefore, early escalation to biologics before the patient's condition worsens may be the basis for improving the overall prognosis.

References

Park, Sang Hyoung et al. “Clinical Characteristics and Long-term Prognosis of Elderly-Onset Ulcerative Colitis in a Population-Based Cohort in the Songpa-Kangdong District of Seoul, Korea.” Gut and liver vol. 15,5 (2021): 742-751. doi:10.5009/gnl20289
Park, Sunhee et al. “Histological Disease Activity as a Predictor of Clinical Relapse Among Patients With Ulcerative Colitis: Systematic Review and Meta-Analysis.” The American journal of gastroenterology vol. 111,12 (2016): 1692-1701. doi:10.1038/ajg.2016.418

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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