Detection of fucosylated haptoglobin using the 10-7G antibody as a biomarker for evaluating endoscopic remission in ulcerative colitis

Abstract Background Many patients with ulcerative colitis (UC) in clinical remission frequently complain of bowel symptoms such as increased stool frequency (SF) and rectal bleeding (RB). However, studies on these patient-reported outcomes in patients with inactive UC are limited, especially in Korea. Therefore, we investigated the prevalence and risk factors of bowel symptoms in Korean patients with inactive UC. Methods We investigated the prevalence of bowel symptoms in patients with endoscopically quiescent UC between June 1989 and December 2016 using a well-characterized referral center-based cohort. The Mayo clinic score (MCS) was used to evaluate bowel symptoms at the most recent visit near the date of endoscopy. Clinical characteristics of the patients were compared based on the presence or absence of bowel symptoms. Results Overall, 741 patients with endoscopically quiescent UC were identified, of whom 222 (30%) and 48 (6.5%) had an SF and RB subscore of ≥ 1, respectively. Patients with bowel symptoms (SF + RB ≥ 1; n = 244 [32.9%]) had higher rates of left-sided colitis (E2) or extensive colitis (E3) than patients without bowel symptoms (SF + RB = 0; n = 497 [67.1%]; P = 0.002). Multivariate analysis revealed that female sex (odds ratio [OR]: 1.568; 95% confidence interval [CI]: 1.023–2.402; P = 0.039) and E2 or E3 (OR 1.411; 95% CI 1.020–1.951; P = 0.038) were the significant risk factors for increased SF. Conclusions This study revealed that one-third of patients with endoscopically quiescent UC reported increased SF. Female sex and disease extent may be associated with bowel symptoms.

Download Full-text

A15 EFFICACY AND SAFETY OF FILGOTINIB AS INDUCTION THERAPY FOR PATIENTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS: RESULTS FROM THE PHASE 2B/3 SELECTION STUDY

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.014 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 18-20

Author(s):

B G Feagan ◽

E V Loftus ◽

S Danese ◽

S Vermeire ◽

W J Sandborn ◽

...

Keyword(s):

Ulcerative Colitis ◽

Induction Therapy ◽

Clinical Remission ◽

Active Ulcerative Colitis ◽

Treatment Groups ◽

Disease Characteristics ◽

Serious Infections ◽

Endoscopic Remission ◽

Induction Study ◽

Secondary Endpoints

Abstract Aims The SELECTION (NCT02914522) Induction Studies evaluated the efficacy/safety of filgotinib (FIL), a preferential JAK1 inhibitor, as induction therapy for patients (pts) with moderately to severely active ulcerative colitis (UC) who were biologic-naïve but failed conventional therapy (Induction Study A) or failed prior biologics (Induction Study B). Methods Pts were randomized 2:2:1 to once–daily FIL 200mg, FIL 100mg or placebo (PBO). The primary (clinical remission), key secondary (Mayo Clinic Score [MCS] remission, endoscopic remission, and histologic remission), and exploratory endpoints (MCS response and endoscopic improvement) were assessed at Week 10. Results In both studies, baseline demographics and disease characteristics were similar across treatment groups. In Study A, 659 pts were randomized and treated. Baseline mean MCS was 8.6 and 56% had a Mayo endoscopic subscore (ES)=3. A significantly higher proportion of biologic-naïve pts on FIL 200mg achieved clinical remission vs PBO and all key secondary endpoints (Table). In Study B, 689 pts were randomized and treated. Baseline mean MCS was 9.3 and 78% had ES=3. Prior treatment failures were: anti-TNF (86%), vedolizumab (52%) and both (dual-refractory; 43%). A significantly higher proportion of biologic-experienced pts on FIL 200mg achieved clinical remission vs PBO. In Studies A and B, a greater proportion of pts on FIL 200 mg achieved an MCS response and endoscopic improvement vs PBO. The rates of AEs, serious AEs and discontinuations due to AEs were similar across FIL and PBO groups during induction. In the PBO, FIL 100mg and FIL 200mg groups, serious infections occurred in 0.7%, 0.7% and 0.4% pts in Study A and 1.4%, 1.4% and 0.8% pts in Study B; H Zoster occurred in <1% in both groups for both cohorts. Conclusions SELECTION included a high proportion of dual-refractory pts, and pts with severe endoscopic disease. Both doses of FIL were well tolerated. Filgotinib 200mg was effective induction therapy for both biologic-naïve/-experienced pts with moderately to severely active UC. Funding Agencies None

Download Full-text

Middle-term prognosis in patients with ulcerative colitis who achieved clinical and endoscopic remission by budesonide rectal foam

PLoS ONE ◽

10.1371/journal.pone.0220413 ◽

2019 ◽

Vol 14 (8) ◽

pp. e0220413

Author(s):

Makoto Naganuma ◽

Fumihito Hirai ◽

Kiyonori Kobayashi ◽

Kenji Watanabe ◽

Ken Takeuchi ◽

...

Keyword(s):

Ulcerative Colitis ◽

Middle Term ◽

Endoscopic Remission ◽

Rectal Foam

Download Full-text

Ménétrier’s disease in a patient with refractory ulcerative colitis: a clinical challenge and review of the literature

BMJ Case Reports ◽

10.1136/bcr-2021-246137 ◽

2021 ◽

Vol 14 (10) ◽

pp. e246137

Author(s):

Sofia Rao ◽

Anna Viola ◽

Omar Ksissa ◽

Walter Fries

Keyword(s):

Ulcerative Colitis ◽

Rare Disease ◽

Treatment Options ◽

Review Of The Literature ◽

Protein Loss ◽

Menetrier’S Disease ◽

Clinical Challenge ◽

Endoscopic Remission ◽

Ménétrier's Disease ◽

Menetrier's Disease

Ménétrier’s disease (MD) is a rare disease of the stomach, characterised by hypertrophic gastric folds leading to protein loss. The association with ulcerative colitis (UC) is rare but has been reported in the literature. We report a case of a 29-year-old male affected by UC with an additional diagnosis of MD 3 years after UC diagnosis. UC was refractory to several treatment lines (thiopurines, infliximab, vedolizumab and ustekinumab), and the patient underwent colectomy. Octreotide was administered for MD normalising blood biochemistry, but it was not effective in inducing endoscopic remission of the stomach. Treatment options in patients with MD and UC are discussed.

Download Full-text

Histologic Evaluation Using the Robarts Histopathology Index in Patients With Ulcerative Colitis in Deep Remission and the Association of Histologic Remission With Risk of Relapse

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab340 ◽

2022 ◽

Author(s):

Jin Park ◽

Soo Jin Kang ◽

Hyuk Yoon ◽

Jihye Park ◽

Hyeon Jeong Oh ◽

...

Keyword(s):

Ulcerative Colitis ◽

Proportional Hazards Model ◽

Characteristic Curve ◽

Multivariable Analysis ◽

Fecal Calprotectin ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Clinical Relapse ◽

Endoscopic Remission ◽

Risk Of Relapse

Abstract Background This study prospectively evaluated the risk of relapse according to the status of histologic activity in patients with ulcerative colitis (UC) who achieved deep remission. Methods Patients with UC in clinical remission (partial Mayo score ≤1) and endoscopic remission (ulcerative colitis endoscopic index of severity ≤1) were enrolled. Rectal biopsies were performed in patients, and histologic remission was defined as a Robarts histopathology index of ≤3. Receiver-operating characteristic curve analysis was conducted to determine fecal calprotectin cutoff values for histologic remission. The cumulative risk of relapse was evaluated using the Cox proportional hazards model. Results Among the 187 patients enrolled, 82 (43.9%) achieved histologic remission. The best cutoff value of fecal calprotectin for predicting histologic remission was 80 mg/kg (area under the curve of 0.646, sensitivity of 74%, and specificity of 61%). Among 142 patients who were followed up for >3 months, 56 (39.4%) showed clinical relapse during a median of 42 weeks. The risk of relapse was lower in patients with histologic remission than in those with histologic activity (P = .026). In multivariable analysis, histologic remission (hazard ratio [HR], 0.551; 95% confidence interval [CI], 0.316-0.958; P = .035), elevated C-reactive protein levels (HR, 3.652; 95% CI, 1.400-9.526; P = .008), and history of steroid use (HR, 2.398; 95% CI, 1.196-4.808; P = .014) were significantly associated with clinical relapse. Conclusions In patients with UC who achieved clinical and endoscopic remission, histologic remission was independently associated with a lower risk of clinical relapse.

Download Full-text

Effectiveness of treatment of moderate ulcerative colitis with prolonged mesalazine in real clinical practice

Medical Council ◽

10.21518/2079-701x-2021-15-144-151 ◽

2021 ◽

pp. 144-151

Author(s):

O. V. Knyazev ◽

A. V. Kagramanova ◽

A. A. Lishchinskaya

Keyword(s):

Ulcerative Colitis ◽

Clinical Remission ◽

Topical Therapy ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Prolonged Release ◽

Mayo Score ◽

Endoscopic Remission ◽

Oral Mesalazine ◽

High Doses

Introduction. Ulcerative colitis (UC) is one of the severe therapeutic diseases. High doses of oral granular mesalazine are required to maintain clinical and endoscopic remission of UC, which may be sufficient and supposedly more acceptable for patients, as some studies showed that adherence to topical therapy is significantly lower than to oral 5-ASA drugs.Objective of the study. To evaluate the efficacy of therapy of patients with moderate left-sided ulcerative colitis (UC) and pancolitis receiving prolonged-release ethylcellulose-coated mesalazine.Materials and methods. The evaluation of the outcomes of treatment of UC patients who received prolonged-release mesalazine was carried out. We examined 87 patients with UC who received granular ethylcellulose-coated mesalazine, of those 38 (43.7%) men and 49 (56.3%) women. The average age of the enrolled patients was 38.3 ± 12.6 years.Results and discussion. After 2 weeks from the beginning of therapy with prolonged-release mesalazine, the majority of patients – 71 (81.6%) responded to the therapy. After 12 weeks, 71 (81.6%) of 87 UC patients, who responded to therapy with prolongedrelease mesalazine, remained in clinical remission. On average, the Mayo score in the group decreased from 7.6 ± 0.99 to 2.6 ± 0.25 points. There was a significant decrease in CRP, ESR, leukocytosis, and fecal calprotectin. After 26 weeks, Mayo score in the group of patients remained on average at the level of 2.2–2.3 points. The number of UC patients with colon mucosal healing was 32 (36.8%) patients. A year after the start of therapy with prolonged-release mesalazine, 69 (79.3%) UC patients who responded to therapy had a clinical remission, of those 32 (36.8%) patients had a clinical and endoscopic remission. During the year of observation, no case of surgical intervention or re-hospitalization due to exacerbation of the disease was recorded in patients with UC who achieved remission.Conclusions. Treatment of moderate active UC should begin with oral mesalazine ≥ 3 g per day in combination with topical mesalazine. The prolonged-release mesalazines are the most preferred

Download Full-text

Segmental Colectomy: An Alternative for Ulcerative Colitis in Endoscopic Remission?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa141 ◽

2020 ◽

Author(s):

Rogério Serafim Parra ◽

Marley Ribeiro Feitosa ◽

Omar Féres

Keyword(s):

Ulcerative Colitis ◽

Endoscopic Remission ◽

Segmental Colectomy

Download Full-text

Thiopurine Treatment in Ulcerative Colitis: A Critical Review of the Evidence for Current Clinical Practice

Inflammatory Bowel Diseases ◽

10.1093/ibd/izx025 ◽

2017 ◽

Vol 24 (1) ◽

pp. 67-77 ◽

Cited By ~ 1

Author(s):

Sara van Gennep ◽

Nanne K de Boer ◽

Geert R D’Haens ◽

Mark Löwenberg

Keyword(s):

Ulcerative Colitis ◽

Clinical Practice ◽

Critical Review ◽

Maintenance Treatment ◽

Randomized Trials ◽

Current Clinical Practice ◽

Sufficient Power ◽

Significant Difference ◽

Endoscopic Remission ◽

Remission Rates

Abstract Background Due to toxicity problems and controversial evidence, thiopurine use in ulcerative colitis (UC) has faced a lot of criticism. We present a critical review of the literature on efficacy of thiopurines in UC. Methods Studies evaluating therapeutic efficacy of thiopurine remission induction and/or maintenance treatment in UC were identified using the Cochrane Library, MEDLINE, and EMBASE. Results Out of 5 randomized trials on thiopurine induction treatment, 3 demonstrated a significant effect of thiopurine treatment vs mesalamine or placebo in steroid-dependent UC patients: (1) lower endoscopic activity scores, (2) higher clinical remission rates, and (3) more patients who discontinued steroids. Two found no significant difference in clinical and endoscopic remission of azathioprine compared with sulfasalazine or placebo in patients with active UC. Out of 7 randomized trials on thiopurine maintenance treatment, 4 demonstrated significant higher clinical and endoscopic remission rates in thiopurine-treated patients compared with placebo or mesalamine. Three found no significant difference in clinical and endoscopic remission of thiopurine maintenance treatment compared with sulfasalazine or placebo. Conclusions All studies that investigated thiopurine treatment in UC had shortcomings, such as lack of sufficient power, no use of blinding, allowed concomitant treatment with steroids, and no endoscopy to confirm active disease at study entry or to evaluate therapeutic efficacy. Hence, current clinical practice of thiopurine treatment in UC is based on minimal and controversial evidence. This underscores the need for clinical studies with sufficient power and objective end points in order to determine efficacy of thiopurines in UC. 10.1093/ibd/izx025_video1 izx025.video1 5732762967001

Download Full-text

P642 Impact of histological and endoscopic remission in clinical recurrence and recurrence-free time in ulcerative colitis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.766 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S409-S409

Author(s):

A. Ponte ◽

R. Pinho ◽

S. Fernandes ◽

A. Rodrigues ◽

L. Alberto ◽

...

Keyword(s):

Ulcerative Colitis ◽

Free Time ◽

Clinical Recurrence ◽

Endoscopic Remission

Download Full-text

P471 What is the appropriate cut-off value of CRP to predict endoscopic remission in ulcerative colitis patients with clinical remission?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.600 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S415-S415

Author(s):

J Shin ◽

G Seong ◽

J H Song ◽

S M Kong ◽

T J Kim ◽

...

Keyword(s):

Ulcerative Colitis ◽

Sensitivity And Specificity ◽

Clinical Remission ◽

Activity Index ◽

Area Under The Curve ◽

Endoscopic Evaluation ◽

Faecal Calprotectin ◽

Reactive Protein ◽

Endoscopic Remission ◽

Low Sensitivity

Abstract Background A noninvasive and reliable markers for predicting endoscopic remission (ER) in ulcerative colitis (UC) patients with clinical remission (CR) provide important information in predicting disease progression and in determining treatment. Faecal calprotectin test is known to be the most accurate to predict ER, but patients are reluctant to handle faecal materials. C-reactive protein (CRP) is one of the surrogate markers for assessing disease activity, but it is known to have low sensitivity and specificity of normal CRP value (<0.3 mg/dl). The sensitivity of the CRP test has been improved, and even fine values within the normal range can be measured. The aim of this study was to determine appropriate CRP cut-off values for the prediction of ER in UC patients with CR even though within normal CRP range. Methods A total of 132 UC patients who underwent endoscopic evaluation in CR were retrospectively reviewed. Serum biomarkers including haemoglobin, leukocytes, platelets, erythrocyte sedimentation rate, and CRP were evaluated within 1 week period from endoscopic evaluation. The clinical and endoscopic activity was measured by simple clinical colitis activity index and endoscopic Mayo subscore. Results In UC patient with CR, CRP level was significantly lower in ER (median 0.05, 0.03–2.57) vs. non-ER (median 0.11 0.03-2.81). (p < 0.005) The proportion of males in non-ER was slightly higher than in ER (24, 72.7% vs. 52, 52.5 %; p = 0.042), and only gender and CRP showed statistical differences in baseline clinical characteristics. CRP had predictive value of ER [Area under the curve (AUC = 0.760)] and the sensitivity was 71.4%, specificity was 71.7 % at cut-off value of 0.09mg/dl. In contrast, the sensitivity and specificity of normal CRP (0.3mg/dl) were low. (sensitivity 27.3%, specificity 90.9%). Conclusion Norma CRP cut-off values are not sufficient to reflect ER. It may be helpful to change the CRP cut-off value that predicts ER in CR to value other than 0.3 mg/dl.

Download Full-text