‘Treat to Target’ in Mild to Moderate Ulcerative Colitis: Evidence to Support this Strategy

2020 ◽  
Vol 22 (1) ◽  
pp. 117-125
Author(s):  
Arianna Dal Buono ◽  
Giulia Roda ◽  
Marjorie Argollo ◽  
Kristine Paridaens ◽  
Laurent PeyrinBiroulet ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Practice ◽  
Mucosal Healing ◽  
Current Evidence ◽  
Treat To Target ◽  
Pubmed Search ◽  
Objective Outcomes ◽  
Histological Remission ◽  
Approved Drugs

Background: The management of chronic conditions, above all rheumatic disease and diabetes has adopted a "treat to target" strategy where treatment aims to achieve objective outcomes; this has emerged as applicable in ulcerative colitis (UC) as well. Targets are demonstrated to prevent end-organ disfunction, specifically bowel damage and its complications, lastly colorectal cancer. Recently, the scientific community has tried to define further targets beyond those currently recommended, namely mucosal healing and clinical remission. Studies that prospectively investigated this approach in UC are scanty and a treat-to-target (T2T) algorithm is not routinely inserted in daily clinical practice. Objective: We aim to review current evidence on T2T in UC and to discuss its adoption in routine clinical practice as well as in clinical trials. Methods: A PubMed search was conducted in February 2020 to identify published papers investigating targets’ achievement rates in UC. Results: Different targets can be achieved through approved drugs for mild to moderate UC; histological remission is emerging as a robust target with respect to long-term outcomes. Conclusion: Further studies to compare a T2T strategy to the traditional care are needed, particularly in the mild to moderate spectrum of disease.

scholarly journals Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?

2021 ◽  
Vol 10 (23) ◽  
pp. 5551
Author(s):  
Panu Wetwittayakhlang ◽  
Livia Lontai ◽  
Lorant Gonczi ◽  
Petra A. Golovics ◽  
Gustavo Drügg Hahn ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Current Evidence ◽  
Treat To Target ◽  
Therapeutic Goal ◽  
Treatment Targets ◽  
Patient Reported ◽  
Clinical Biomarker ◽  
Endoscopic Score ◽  
Histological Remission

The main therapeutic goal of ulcerative colitis (UC) is to induce and maintain remission to prevent long-term disease progression. Treat-to-target strategies, first introduced by the STRIDE consensus and updated in 2021, have shifted focus from symptomatic control toward more stringent objective endpoints. Today, patient monitoring should be based on a combination of biomarkers and clinical scores, while patient-reported outcomes could be used as short-term targets in monitoring disease activity and therapeutic response. In addition, endoscopic healing was the preferred long-term goal in UC. A Mayo endoscopic score (MES) ≤ 1 can be recommended as a minimum target. However, recent evidence suggests that more stringent endoscopic goals (MES of 0) are associated with superior outcomes. Recently, emerging data support that histological remission (HR) is a superior prognostic factor to endoscopic healing in predicting long-term remission. Despite not yet being recommended as a target, HR may become an important potential therapeutic goal in UC. However, it remains questionable if histological healing should be used as a routine assessment in addition to clinical, biomarker, and endoscopic targets in all patients. Therefore, in this review, our aim was to discuss the current evidence for the different treatment targets and their value in everyday clinical practice.

scholarly journals Clinical Study of the Relation between Mucosal Healing and Long-Term Outcomes in Ulcerative Colitis

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Kaoru Yokoyama ◽  
Kiyonori Kobayashi ◽  
Miyuki Mukae ◽  
Miwa Sada ◽  
Wasaburo Koizumi
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Study ◽  
Mucosal Healing ◽  
Long Term Outcomes

scholarly journals Is histological remission of ulcerative colitis achievable?

2021 ◽  
Vol 93 (8) ◽  
pp. 975-981
Author(s):  
Oleg V. Knyazev ◽  
Anna V. Kagramanova ◽  
Sergei G. Khomeriki ◽  
Asfold I. Parfenov
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Remission ◽  
Therapeutic Efficacy ◽  
Disease Recurrence ◽  
Mucosal Healing ◽  
Colon Mucosa ◽  
Normal Colon ◽  
Laboratory Markers ◽  
Important Challenge ◽  
Histological Remission

Current conception of deep remission in patients with ulcerative colitis (UC) consists of clinical remission, endoscopic mucosal healing and normalization of laboratory markers. Histological remission should not be used as a primary end point for therapeutic efficacy, but instead should be considered as a marker of deep remission. The main goal of UC treatment should be focused on endoscopic healing of colon mucosa, decrease of inflammation activity, prolonged remission, absence of disease recurrence, and also histologic remission. Nevertheless, the term histologic remission has not yet been fully validated and no histologic indexes have been standardized. We need single unified definition for remission, based on multicentral studies analysis. One of important challenge is restoration of normal colon mucosal and results of multiple studies showed contradictory tests for assessing histologic remission, thus remaining an issue for further discussion.

scholarly journals OP26 The first real-life multicentre prospective validation study of the electronic chromoendoscopy score (Paddington International Virtual ChromoendoScopy ScOre) and its outcome in ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S023-S024 ◽  
Author(s):  
M Iacucci ◽  
S C Smith ◽  
A Bazarova ◽  
U N Shivaji ◽  
P Bhandari ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Validation Study ◽  
Real Life ◽  
Mucosal Healing ◽  
Vascular Changes ◽  
Important Goal ◽  
Kaplan Meier ◽  
Virtual Chromoendoscopy

Abstract Background Mucosal healing is an important goal in the treatment of ulcerative colitis (UC). The newly published PICaSSO score characterises subtle mucosal and vascular changes and defines mucosal healing. We aimed to validate in real-life the PICaSSO score and assess its ability to predict relapse. Methods Patients with UC were prospectively recruited from 11 international centres. Participating endoscopists experienced in IBD received training on PICaSSO before starting the study. The rectum and sigmoid were examined using iScan 1,2 and 3 (Pentax, Japan) and inflammatory activity was assessed using UCEIS and PICaSSO. Biopsies were taken for the histological assessment using Robarts Histological Index (RHI) and Nancy. Follow-up was obtained at 12 months. Results A total of 278 patients were recruited (Table 1). The diagnostic performance in predicting histologic healing is shown in Table 2. When using PICaSSO score of ≤3 for mucosal and vascular architecture the AUROC to predict healing by RHI is 0.79 (95% CI 0.74–0.85) and 0.73 (95% CI 0.68–0.80) respectively and when using the Nancy score the AUROC is 0.78 (95% CI 0.72–0.84) and 0.77 (0.71–0.84). A total PICaSSO score of ≤8 and UCEIS score of ≤1 predicts remission at 12 months with an AUROC of 0.73 (0.65–0.80) and 0.71 (0.64–0.79). A Kaplan–Meier curve shows a favourable survival probability without relapse with a PICASSO score of ≤8 (Figure 1). Conclusion This real-life validation study shows the PICaSSO score can predict accurately histological healing and long-term remission and can be a useful tool in the management of UC.

Mucosal healing and histological remission in pediatric ulcerative colitis: Does the target change the outcomes?

2017 ◽  
Vol 49 (4) ◽  
pp. e262
Author(s):  
M. Aloi ◽  
G. D’Arcangelo ◽  
S. Oliva ◽  
M. Peresso ◽  
F. Viola ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Mucosal Healing ◽  
Histological Remission

scholarly journals Tu1154 Mucosal Healing Without Endoscopic Activity Predicts Long-Term Clinical Remission in Patients With Ulcerative Colitis

2013 ◽  
Vol 144 (5) ◽  
pp. S-776-S-777 ◽  
Author(s):  
Nagamu Inoue ◽  
Kaoru Takabayashi ◽  
Tetsuro Takayama ◽  
Katsuyoshi Matsuoka ◽  
Makoto Naganuma ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Remission ◽  
Mucosal Healing

PA.168 MUCOSAL HEALING IN ULCERATIVE COLITIS PATIENTS IN LONG-TERM TREATMENT WITH INFLIXIMAB

2008 ◽  
Vol 40 ◽  
pp. S137
Author(s):  
A. Papa ◽  
I. De Vitis ◽  
S. Guglielmo ◽  
A. Tursi ◽  
G. Brandimarte ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Mucosal Healing ◽  
Term Treatment ◽  
Long Term Treatment

scholarly journals P476 Effectiveness and safety of ustekinumab in ulcerative colitis: Real-world evidence from the ENEIDA registry

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S465-S466
Author(s):  
M Chaparro ◽  
A Garre ◽  
M Iborra ◽  
M Sierra ◽  
M Barreiro-de Acosta ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Practice ◽  
Elevated Serum ◽  
Real Life ◽  
Development Program ◽  
Lower Probability ◽  
Clinical Activity ◽  
Mayo Score

Abstract Background The development program (UNIFI) has shown promising results of ustekinumab in ulcerative colitis (UC) treatment that should be confirmed in clinical practice. Aims Primary: to evaluate the durability of ustekinumab treatment in UC patients in clinical practice. Secondary: to assess the short-term response (at week 16) and the long-term effectiveness (at maximum follow-up) and to assess the safety of ustekinumab in clinical practice. Methods Patients included in the prospectively maintained ENEIDA registry who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score (PMS) >2] were included. Clinical activity and effectiveness were defined based on PMS. Results 95 patients were included (table 1). At week 16, 53% of patients had clinical response (including 35% of patients in remission) (figure 1). In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with clinical remission. Long-term remission is represented in figure 2. 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at week 16, 63% at week 56, and 59% at week 72 (figure 3); primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. Conclusion Ustekinumab is effective both in the short and the long-term in real-life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.

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