Alimentary TractPredictors of tissue healing in ulcerative colitis patients treated with anti-TNF
Introduction
Ulcerative colitis (UC) is a life-long idiopathic inflammatory bowel disease (IBD) which usually runs a relapsing-remitting course and can be controlled by aminosalicylates and short courses of corticosteroids during its flares [1]. However, in a considerable proportion of patients the disease may be continuously active and refractory to traditional treatment necessitating therapy with thiopurines, biologics, or their combination [2], [3], [4], [5], [6], [7]. Although UC is predominantly a mucosal disease, relentlessly uncontrolled chronic inflammation may end up to destruction of the colon and organ failure, severely affecting patient lives. Given the lack of definitive therapy, treatment aims at relieving patient symptoms, healing the colonic mucosa and alleviating histologic inflammation, since achievement of these targets is associated reduction of disease flares, hospitalizations, complications, colectomies, and development of colorectal cancer and improved quality of life [8], [9], [10], [11], [12], [13]. Consequently, assessment or mucosal healing is now considered an important therapeutic target in UC. [14], [15].
To date, several clinical trials have identified various factors which may predict a disabling course of UC. When present, these factors help identify patients who would mostly benefit from the application of timely and appropriate therapy, such as anti-TNFα agents, aiming at achieving and maintaining a tight control of inflammation early in the course of disease [16], [17], [18]. In contrast, factors predictive of mucosal healing have not yet been identified.
The aim of our study was to prospectively identify factors predictive of mucosal healing in UC patients treated with anti-TNFα agents.
Section snippets
Patients and treatments
Consecutive patients attending the IBD Outpatient Clinics in the three participating tertiary hospitals, with active corticosteroid-dependent or refractory UC, naïve or refractory to AZA who were eligible for treatment with anti-TNFα agents according to the updated ECCO guidelines [19] were prospectively assessed for enrollment in the study. Selection of the particular anti-TNFα agent [infliximab (Remicade®), adalimumab (Humira®), or (after 2013) golimumab (Simponi®)] was left to physician’s
Characteristics of patients
Between September 2010 and January 2015, a total of 67 UC patients in the participating centers received infliximab (n = 56), adalimumab (n = 5), or golimumab (n = 6). Patient and disease characteristics are given in Table 1. Before anti-TNFα treatment, 34 (50.7%) patients were refractory and 33 (49.3%) were naïve to AZA. Thirty of the 33 AZA-naïve patients received combination therapy so that in total 64 of 67 (96.5%) patients received anti-TNF and azathioprine for 6 months followed by anti-TNFα
Discussion
The prognostic importance of mucosal healing in UC was first suggested by Truelove and Richards in 1956 [22]. In the IBSEN study, which dates before the era of the biologic therapy, mucosal healing at one year after the diagnosis of UC was predictive of significantly lower long term colectomy rates compared to patients who lacked mucosal healing [23]. However, clinical remission in association with complete mucosal healing has become a realistic treatment target in the era of biologic therapy
Conflict of interest
None declared.
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