P112 The road to disease control: Combination of histologic and endoscopic remission predicts long-term disease outcome in ulcerative colitis

Bretschneider, F.(1);Kormilez, D.(2);Sari, S.(1);Pflaum, T.(3);Le, H.D.(1);Nikolaus, S.(4);Lassen, A.(4);Rosenstiel, P.(1);Roecken, C.(3);Szymczak, S.(2);Schreiber, S.(4);Aden, K.(4);

(1)Christian-Albrechts-University and University Hospital Schleswig-Holstein, Institute of Clinical Molecular Biology-, Kiel, Germany;(2)University of Luebeck University Hospital Schleswig-Holstein, Institute for Medical Biometry and Statistics, Luebeck, Germany;(3)University Medical Center Schleswig-Holstein Kiel, Institute of Pathology, Kiel, Germany;(4)University Medical Center Schleswig-Holstein Kiel, Department of Medicine I, Kiel, Germany;


Independent assessments of histologic and endoscopic scores are two commonly used parameters as therapeutic endpoints in ulcerative colitis. However, our individual goal for patients is to achieve (long-term) disease-control. It has been recently shown that the individual combination of histologic and endoscopic remission is related to favorable long-term outcomes1. However, real world evidence for the benefit of using combined endoscopic and histologic remission endpoints is scarce.


We collected data from a retrospective cohort study of n=398 patients with active UC who underwent clinical assessment and routine colonoscopy.  All patients donated data and biomaterials at the University Hospital Schleswig-Holstein (Kiel) using the broad consent2. The patients were observed over a minimum of 6 months and three individual outcomes were pre-defined as outcome-endpoints: i) therapy escalation (systemic steroids/new targeted MoA), ii) long-term hospitalization and iii) IBD-related surgery. 


398 UC patients (female: n=166, 41.7%, male: n=232, 58.29% with a median age of 47 years at time of routine colonoscopy) were analyzed. We observed therapy escalation in 134 cases (42.27%), hospitalization in 70 cases (21.21%) and IBD-related surgery in 34 cases (10.66%). Remission at the time of colonoscopy was assessed by endoscopic Mayo (eMayo=0) or Nancy-Index (=0) and used for prediction of long-term outcome.We investigated the benefit of combined endoscopic and histologic remission on long-term outcome by comparing a combination of both eMayo=0 and Nancy=0 against eMayo=0 and Nancy>0. Patients with combined histologic and endoscopic remission show a significantly reduced hazard ratio for all three outcome endpoints, such as therapy escalation (HR 0.20, CI 0.10-0.39, p<0.001), hospitalization (HR 0.24, CI 0.09-0.59, p=0.002) and IBD-related surgery (HR 0.20, CI 0.05-0.84, p=0.028). 


We show that the combined assessment of endoscopic and histologic remission substantially increases the identification of patients with favorable long-term outcome in UC. However, even in patients with combined endoscopic and histologic remission approx. 20% underwent therapy escalation within 6-month period. These data highlight the need of combined endpoints using histology, endoscopy and probably other parameters (e.g. inflammatory biomarkers, patient reported outcomes) to define disease control and predict favorable disease trajectories in the future course of patients with UC.