P406 Disease clearance in patients with ulcerative colitis treated with aminosalicylates
Nascimento, C.(1);Revés, J.(1);Roque Ramos, L.(1);Carolina, P.(1);Fidalgo, C.(1);Glória, L.(1);Torres, J.(1);
(1)Hospital Beatriz Ângelo, Gastrenterology, Loures, Portugal;
Background
Current treatment goals in inflammatory bowel disease include clinical remission and endoscopic healing. A new concept of disease clearance (DC) is emerging as a new therapeutic target in ulcerative colitis (UC). Although not yet clearly defined, it reflects a combination of clinical, endoscopic, and histological remission1. Preliminary data suggest that DC is achievable with biologic therapy. Aim: to evaluate if patients treated with 5-ASA with DC can maintain sustained remission and the incidence of negative disease outcomes.
Methods
We performed a retrospective cohort study including adult patients with confirmed UC treated with 5-ASA. Patients performing colonoscopy with biopsies between 2017 and 2019, with at least 1 year of follow-up were eligible for inclusion. DC was measured at baseline and was defined as clinical (partial Mayo score ≤2), endoscopic (endoscopic Mayo score ≤1) and histological remission (chronic inactive/quiescent colitis)1. Negative disease outcomes included need for systemic steroids, therapy escalation (immunomodulators and/or biologics) and UC-related hospitalization or surgery during follow-up. Kaplan-Meier analysis was performed.
Results
We included 56 patients with UC treated with 5-ASA and with DC at baseline. Mean age at diagnosis was 41.2 ± 15 years, 59% (n=33) were female and mean disease duration was 6.9 ± 7.3 months. History of smoking (current or former) was present in 36% (n=20) of the patients. Most of the patients (54%) presented with left-sided colitis. Mean follow-up was 34.6 ± 10.7 months. During the follow-up, 14.3 % (n=8) had a negative outcome (flare requiring systemic corticosteroids (n=6), therapy escalation to immunomodulator or biologic treatment (n=6) or hospitalization (n=1)). None of the patients needed surgery. Negative outcomes were associated with shorter disease duration (3.4 vs 7.4 years, p=0.003). No other factors were associated with the outcomes namely sex, UC extent, smoker status, age at diagnosis or previous use of corticosteroids. There was no difference on prognosis between patients with baseline endoscopic Mayo score 0 or 1 (p= 0.066). In the survival analysis, the cumulative probability of maintaining remission was 76% at 3 years.
Conclusion
DC in UC patients treated with 5-ASA was associated with a high cumulative probability of maintaining remission, suggesting that the benefits of such stringent endpoint may be independent of the therapy used.
1 S Danese, S Schreiber, E Loftus, Jr., J F Colombel, L Peyrin-Biroulet, C Agboton, D Lindner, R Lirio, B Sands, P271 Evolving Targets in Ulcerative colitis: Defining Disease Clearance in the VARSITY Study, Journal of Crohn's and Colitis,Volume 15, Issue Supplement1, May 2021, Page S305