P253 Histological Remission and Activity as Predictor of Relapse, Hospitalization, and Surgery in Ulcerative Colitis: Systematic Review and Meta-analysis
Shehab, M.(1)*;Akram, S.A.(1);Hassan, A.(1);Alrashed, F.(2);Bessissow, T.(3);
(1)Mubarak Al-Kabeer Hospital, Internal medicine, Kuwait, Kuwait;(2)Kuwait University, Pharmacy practice, Kuwait, Kuwait;(3)McGill University, Internal medicine, Montreal, Canada;
Background
Treatment targets in patients with inflammatory bowel disease (IBD) have evolved over the last two decades. The significance of histological remission as a treatment target in patients with ulcerative colitis (UC) is not well established. The aim of this study is to assess risk of clinical relapse, hospitalizations and need for surgery in patients who achieved histological remission compared to patients with active histology in UC.
Methods
MEDLINE, EMBASE, Cochrane CENTRAL and conference abstracts were searched from inception to October 2022. Inclusion criteria included any randomized controlled trial or observational study that included adult patients with UC who achieved histological remission. The primary outcome was the risk of clinical relapse, hospitalization and need for surgery in patients with UC who achieved histological remission compared to patients with active histology. The outcomes were collected and stratified by 2 time points, 6-12 months and 13 or more months. Random effects model was used to calculate pooled risk ratio (RR) and 95% CIs and I2 statistics were used to assess heterogeneity.
Results
In total 28 studies were included in this meta-analysis. At 6-12 months, the risk of clinical relapse was higher in patients with active histology compared to patients who achieved histological remission (RR= 2.41, 95% confidence interval (CI) 1.69-3.44, p<0.01). There was no difference in risk of hospitalization in patients with histological remission compared to patients with active histology (RR= 4.22, 95% CI 0.91- 19.62, p=0.07). At 13 months or more, the risk of clinical relapse was higher in patients with active histology compared to patients who achieved histological remission (RR= 2.07, 95% CI 1.55-2.76, p<0.01). Risk of hospitalization and need for surgery was also higher in patients with active histology compared to patients who achieved histological remission; (RR= 2.52, 95% CI 1.59-4.00, p<0.01) and (RR= 3.14, 95% CI 1.53-6.45, p<0.01) respectively.
Conclusion
Histological remission in ulcerative colitis represents a treatment target that is not yet routinely sought in practice. Our study suggests that patients who achieve histological remission have better outcomes in UC than those with active histology.