The emerging role of histologic disease activity assessment in ulcerative colitis

Pai, Rish K.; Jairath, Vipul; Casteele, Niels Vande; Rieder, Florian; Parker, Claire E; Lauwers, Gregory Y.

doi:10.1016/j.gie.2018.08.018

Cited by 108 publications

(96 citation statements)

References 53 publications

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“…12 Nevertheless, quantification of inflammation on endoscopic biopsies seems to be a clinically relevant goal in CD trials, given recent developments in validating tools for histologic assessment in ulcerative colitis trials. 13 Vedolizumab is an anti-a4b7-integrin humanized immunoglobulin G1 monoclonal antibody that selectively blocks T-lymphocyte trafficking into the gastrointestinal mucosa. 14 The pivotal GEMINI 2 and 3 trials of vedolizumab in moderately to severely active CD demonstrated the benefit of vedolizumab on clinical outcomes; however, these studies did not include endoscopic, radiologic, or histologic assessments.…”

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confidence: 99%

Endoscopic, Radiologic, and Histologic Healing With Vedolizumab in Patients With Active Crohn’s Disease

et al. 2019

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BACKGROUND & AIMS: Vedolizumab is a gut-selective monoclonal antibody for the treatment of moderately to severely active Crohn's disease (CD). We performed a prospective study of endoscopic, radiologic, and histologic healing in patients with CD who received vedolizumab therapy. METHODS: We performed a phase 3b, open-label, single-group study of 101 patients with at least 3 months of active CD (a CD Activity Index [CDAI] score of 220-450, a simple endoscopic score for CD [SES-CD] of 7 or more, 1 or more mucosal ulcerations [identified by endoscopy], and failure of conventional therapy) from March 2015 through December 2017. Among the patients enrolled, 54.5% had previous failure of 1 or more tumor necrosis factor (TNF) antagonists and 44.6% had severe endoscopic disease activity (SES-CD scores above 15) at baseline. Participants received vedolizumab (300 mg intravenously) at weeks 0, 2, and 6, and then every 8 weeks thereafter, for 26 weeks (primary study) or 52 weeks (substudy, 56 patients). The primary endpoint at week 26 was endoscopic remission (SES-CD score of 4 or less); other endpoints included endoscopic response (50% reduction in SES-CD), radiologic remission (magnetic resonance index of activity score below 7), and histologic response (modified global histologic disease activity score of 4 or less). RESULTS: At week 26, 11.9% of patients were in endoscopic remission (95% confidence interval [CI] 6.3-9.8); at week 52, 17.9% of the patients were in endoscopic remission (95% CI 8.9-30.4). Higher proportions of patients naïve to TNF antagonists achieved endoscopic remission than patients with TNF-antagonist-failure at weeks 26 and 52. Higher proportion of patients with moderate CD (SES-CD scores, 7-15) achieved endoscopic remission at weeks 26 and 52 than patients with severe CD (SES-CD scores above 15). The proportion of patients with complete mucosal healing increased over time, with greater rates of healing in the colon than in the ileum. Remission was detected by magnetic resonance enterography in 21.9% of patients at week 26 (95% CI 9.3-40.0) and in 38.1% at week 52 (95% CI 18.1-61.6). At week 26, 24.4% of patients had a histologic response in the colon (95% CI 15.3-35.4) and 28.3% of patients had a histologic response in the ileum (95% CI 17.5-41.4). At week 52, 20.5% of patients had a histologic response in the colon (95% CI 9.8-35.3) and 34.3% of patients had a histologic response in the ileum (95% CI 19.1-52.2). There were no notable safety issues, including worsening of extraintestinal manifestations. CONCLUSIONS: In a phase 3b trial, we found that 26 and 52 weeks of treatment with vedolizumab (300 mg, at weeks 0, 2, and 6, and then every 8 weeks thereafter) induces endoscopic, radiologic, and histologic healing in patients with moderately to severely active CD. ClinicalTrials.gov no: NCT02425111.

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Endoscopic, Radiologic, and Histologic Healing With Vedolizumab in Patients With Active Crohn’s Disease

et al. 2019

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“…Recommendations for assessing histological activity in UC, as proposed by various experts and the ECCO guidelines 6,7,12,13 include examination of 2 properly fixed biopsies sampled from each segment of colon, including rectum and terminal ileum, especially from the most affected areas (particularly ulcers). This sampling pattern would increase the likeliness to adequately assess the presence and severity of lesions as UC may have discontinuous appearance as consequence of natural evolution or as effect of treatment 1 .…”

Section: Discussionmentioning

confidence: 99%

Histological scoring systems in ulcerative colitis patients: a routine practice perspective

Curte¹,

Becheanu²,

ANDREI³

et al. 2020

Arch Balk Med Union

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Systèmes de grading histologique chez les patients atteints de colite ulcéreuse: une perspective pratique de routine Introduction. La guérison histologique est devenue un objectif thérapeutique chez les patients atteints de colite ulcéreuse. Cependant, un consensus sur sa définition précise n'a pas encore été atteint. Un grand nombre de systèmes de grading histologique complexes pour la colite ulcéreuse sont disponibles dans la littérature, ce qui rend la standardisation compliquée. L'objectif de l'étude était d'identifier un système de grading histologique adapté à la pratique de routine et de contribuer ainsi à la standardisation du rapport histologique de l'activité inflammatoire dans la colite ulcéreuse. Matériaux et méthodes. Nous avons examiné rétrospectivement et noté 64 lames colorées H&E en utilisant l'index de Nancy (NI), le score Geboes (GS) et l'indice histopathologique Robarts (RHI) par trois pathologistes indépendants. Le niveau d'accord

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“…The goals of medication therapy are  inducing and maintaining remission  improving the person's quality of life. Many people with ulcerative colitis require medication therapy indefinitely, unless they have their colon and rectum surgically removed [14,15].Health care providers will prescribe the medications that best treat a person's symptoms:aminosalicylates,corticosteroids,immunomodulator s,biologics, also called anti-TNF therapies,other medications [16]. Depending on the location of the symptoms in the colon, health care providers may recommend a person take medications by:enema, which involves flushing liquid medication into the rectum using a special wash bottle.…”

Section: Discussionmentioning

confidence: 99%

Case Report on Ulcerative Colitis in 16 year girl

MD.Salma¹,

Y.Siva²,

Narendra³

2020

World Journal of Current Med and Pharm Research

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Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder that involves any part of the colon starting in the rectum in a continuous fashion presenting typically with symptoms such as bloody diarrhea, abdominal pain, and rectal urgency.The clinical presentation of the disease usually dictates the choice of pharmacologic therapy, where the goal is to first induce remission and then maintain a corticosteroid-free remission. UC is diagnosed based on clinical presentation and endoscopic evidence of inflammation in the colon starting in the rectum and extending proximally in the colon. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding.

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The emerging role of histologic disease activity assessment in ulcerative colitis

Abstract: Although rarely used to measure inflammation and guide therapy, histologic disease activity is predictive of important clinical outcomes in UC. Randomized controlled trials are needed to determine whether histology should function as a treatment target.

Cited by 108 publications

References 53 publications

Endoscopic, Radiologic, and Histologic Healing With Vedolizumab in Patients With Active Crohn’s Disease

Endoscopic, Radiologic, and Histologic Healing With Vedolizumab in Patients With Active Crohn’s Disease

Histological scoring systems in ulcerative colitis patients: a routine practice perspective

Case Report on Ulcerative Colitis in 16 year girl

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