Predictors of mucosal healing during induction therapy in patients with acute moderate‐to‐severe ulcerative colitis

Abstract

Background and Aim The treat‐to‐target strategy has emerged in ulcerative colitis management. Mucosal healing is the best target, albeit not in induction therapy of acute diseases as clinical conditions vary over a short duration. To determine the targets during induction therapy for acute ulcerative colitis, we identified markers to predict mucosal healing at 3 and 12 months of initiating the induction therapy. Methods This single‐center prospective observational study enrolling 61 adult patients hospitalized for disease exacerbation collected the partial Mayo scores, ulcerative colitis endoscopic index of severity, fecal markers, and laboratory data (0 day, 2 weeks, and 3 and 12 months) of initiating induction therapy. Results At 2 weeks, patients with mucosal healing at 3 months had had lower partial Mayo and ulcerative colitis endoscopic index of severity scores and higher white blood cell count and total cholesterol than those without mucosal healing. At 3 months, patients with mucosal healing at 12 months had had lower partial Mayo and ulcerative colitis endoscopic index of severity scores than those without mucosal healing. A kinetic analysis demonstrated a difference in the partial Mayo scores and total cholesterol and albumin levels at 2 weeks and in the ulcerative colitis endoscopic index of severity, fecal calprotectin, and fecal immunochemical tests at 3 months between patients who achieved mucosal healing at 12 months and those who did not. Conclusions Partial Mayo scores and total cholesterol levels act as short‐term therapeutic targets during induction therapy in patients with acute ulcerative colitis. Mucosal healing at 3 months correlates to longer time mucosal healing.

Systematic review with meta‐analysis: effect of inflammatory bowel disease therapy on lipid levels

“…The treatment regimen of corticosteroids consisted of (a) methylprednisolone weekly dose intravenous bolus‐administered vs conventional orally taken daily (both arms 12‐week tapering regimen starting from 450 mg/wk) and (b) next‐generation budesonide‐MMX orally (8‐week regimen of 9 mg stable dose). In the third study, the specification of type and dose of corticosteroids was not disclosed 9,27,29 . Anti‐TNFα agents used included infliximab only, 9,28 either infliximab or adalimumab (n = 104 and n = 10, respectively), 14 and unspecified anti‐TNFα agents 29 .…”

“…Agreement between reviewers for trial eligibility was good (κ statistic 0.74). We successfully contacted 11 authors: from 8 studies individual patient data were shared, 9,10,13,14,24‐27 from three studies aggregated data were provided 28‐30 …”

“…We successfully contacted 11 authors: from 8 studies individual patient data were shared, 9 , 10 , 13 , 14 , 24 , 25 , 26 , 27 from three studies aggregated data were provided. 28 , 29 , 30 …”

A Scoring System to Determine Patients’ Risk of Colectomy Within 1 Year After Hospital Admission for Acute Severe Ulcerative Colitis

“…Fecal calprotectin seems to have a predictive value in ASUC, but it was not routinely measured in our centers 6,34 . Moreover, we focused on colectomy after ASUC, but, nowadays, it would be interesting to have predictors of others issues such as mucosal healing, or success of specific biologics or small molecules 35 .…”

The efficacy of linked color imaging for the endoscopic diagnosis of mucosal healing in quiescent ulcerative colitis

“…Furthermore, it has been found that the 10‐year cumulative risk of colectomy is 10–15% 5 . To avoid these complications, colonic mucosal healing has gained progressive importance in the management of UC patients 6–8 …”