Stricter treatment endpoints for UC lower risk of relapse

Ulcerative colitis (UC) patients who satisfy a more rigorous definition of disease remission are less likely to relapse, reports a new meta-analysis.

A systematic review of online databases resulted in 31 studies eligible for quantitative analysis. The researchers selected cohort studies reporting on adults whose UC was in endoscopic remission. Only reports that had a minimum 12-month risk of clinical relapse using the Mayo endoscopy subscore (MES) and/or histological disease activity were eligible.

Pooled analysis of 17 studies (n=2,608) showed that UC patients in clinical remission who achieved endoscopic remission (MES score 0) had a 52-percent lower likelihood of clinical remission than those still showing mild endoscopic activity (MES score 1; relative risk [RR], 0.48, 95 percent confidence interval [CI], 0.37–0.62).

Eight studies further showed that patients who still had mild endoscopic activity carried a median 12-month risk of clinical relapse of 28.7 percent. In comparison, the estimated annual risk for those in endoscopic remission was 13.7 percent.

Similarly, more rigorous histological definition corresponded with lower levels of relapse. In a pooled analysis of 20 studies, including 2,265 UC patients in clinical remission and endoscopic healing, those in histological remission saw a 61-percent lower risk of clinical relapse than counterparts with persistent histologic activity.

Achieving both endoscopic and histologic remission further reduced the calculated annual risk of clinical relapse from 13.7 percent (for endoscopic remission alone) to 5.0 percent.

The stricter “endpoints may be considered as preferred treatment targets, but future studies are needed to evaluate the population-level feasibility and cost-effectiveness of treating patients with UC to these endpoints,” the researchers said.