Meucci G, Fasoli R, Saibeni S, et al.. Prognostic significance of endoscopic remission in patients with active ulcerative colitis treated with oral and topical mesalazine: a prospective, multicenter study

Divisione di Gastroenterologia, Ospedale Valduce, Como, Italy.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 04/2006; 18(6):1006-10. DOI: 10.1002/ibd.21838
Source: PubMed


It has been recommended that the treatment of active ulcerative colitis (UC) should be continued until complete healing of endoscopic lesions. However, the evidence supporting this recommendation is scanty. Aims of the present study were to assess the rate of patients with active UC who achieve clinical but not endoscopic remission after treatment with oral plus topical mesalazine and to compare the rate of relapse in patients with clinical/endoscopic remission and those with only clinical remission.
Patients with active mild or moderate UC were eligible. All patients received mesalazine, 4 g/day orally and 2 g/day per rectum for 6 weeks. Those achieving clinical remission underwent colonoscopy: afterwards, all received maintenance treatment with oral mesalazine, 2 g/day orally for 1 year. Clinical remission was defined as normal frequency of bowel movements with formed stools, no abdominal pain, and no blood in the stools. Endoscopic remission was defined as normal-appearing mucosa or only mild redness and/or friability, without either ulcers or erosions.
In all, 81 patients were enrolled. Sixty-one (75%) achieved clinical remission. Endoscopic activity was still present in five (8%). The cumulative rate of relapse at 1 year was 23% in patients with clinical and endoscopic remission and 80% in patients with only clinical remission (P < 0.0001).
Persistence of endoscopic activity is quite infrequent in patients with active UC achieving clinical remission after a 6-week treatment with oral plus topical mesalazine, but is a very strong predictor of early relapse.

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Available from: Gianmichele Meucci, Jan 05, 2014
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    • "In a study by Wright et al. at 1-year follow-up, 40% of patients with mucosal healing while taking corticosteroid therapy did not relapse, as opposed to 18% of patients without mucosal healing [53]. In another study, among patients in clinical remission after receiving six weeks of oral and rectal mesalazine, significantly fewer patients who had mucosal healing at their subsequent colonoscopy experienced clinical relapse at 1 year, compared with patients without mucosal healing at their subsequent colonoscopy (23% vs 80%; P < 0.0001) [54]. Mucosal healing is also thought to be a predictor of decreased risk for colon cancer in UC patients; in a case-control study, authors found that patients with UC and colon cancer had significantly lower rates of previous or current mucosal healing during the study period (odds ratio 0.40; 95% confidence interval 0.21–074); in addition, in this study, UC patients with endoscopically normal mucosa had a similar 5-year rate of colon cancer as the general population [55]. "
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    ABSTRACT: Colonoscopic evaluation is an important tool in the evaluation of ulcerative colitis (UC). UC is divided by disease extent into proctitis, proctosigmoiditis, left-sided colitis, and pan-colitis. In addition, a cecal or peri-appendiceal patch and backwash ileitis are associated with UC. The extent and behavior of UC has been characterized further using various indices and scoring systems; among these systems is the Mayo Score, which is widely used in current clinical trials for new medications. As these medical therapies for UC have developed, achieving mucosal healing with medications has become an important therapeutic objective.
    05/2014; 2(3). DOI:10.1093/gastro/gou028
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    • "Results of these pooled analyses are summarized in Fig. 1. Recently, in a prospective observational study [13], 81 patients with mild to moderately active UC received 5-ASA 4 g/day orally and 2 g/day per rectum for 6 weeks. Sixty-one patients (75%) achieved clinical remission whereas endoscopic activity was still present in only 5 patients (8%). "
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    ABSTRACT: In recent years mucosal healing has emerged as an important therapeutic goal for patients with inflammatory bowel disease. Growing evidence suggests that achieving mucosal healing can improve patient outcomes and, potentially, alter the course of the disease. Drugs currently used in the management of inflammatory bowel disease are potentially able of inducing and maintaining mucosal healing, but the effect size is difficult to assess because of different definitions of mucosal healing, differences in study designs, and timing of endoscopic evaluation. Mucosal healing has been studied extensively in the biologic era. Data available from different sources, such as controlled trials and observational studies, show that anti-TNFα therapies can induce rapid and sustained mucosal healing in a variable percentage of patients with Crohn's disease and ulcerative colits. No controlled study has been designed to identify possible predictors of mucosal healing. Some clinical characteristics such as extensive disease, young age at diagnosis, and smoking status may be predictive of a more aggressive clinical course and, presumably, of a reduced clinical and endoscopic response to therapy. Changes and normalization of C-reactive protein and faecal calprotectin may be useful tools to predict outcomes, guide the timing for endoscopic evaluation and, possibly, reduce the need of endoscopic evaluation in assessing mucosal healing.
    Digestive and Liver Disease 09/2013; 45(12). DOI:10.1016/j.dld.2013.07.006 · 2.96 Impact Factor
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    ABSTRACT: Two 8-week, randomized, placebo-controlled parent studies, SPD476-301 (by Lichtenstein and associates) and SPD476-302 (by Kamm and colleagues), of MMX Multi Matrix System (MMX) mesalamine have evaluated the induction of remission in ulcerative colitis patients, and a third study has evaluated the maintenance of remission in patients from these parent studies. Here, we examine data only from patients who received MMX mesalamine 2.4 g or 4.8 g daily in these trials. In total, 63.6% of patients (220/346) achieved remission following 8–16 weeks of MMX mesalamine therapy. Among these 220 eligible patients, 218 entered the 12-month maintenance phase, and of this group, 89.9% (196/218) were relapse-free at study end. Overall, 56.6% (196/346) of patients who started MMX mesalamine therapy both achieved and maintained remission for 12 months. The adverse-event profile of MMX mesalamine was similar to the profile of the parent studies’ placebo arms at all doses and frequencies. Therefore, the majority of patients with active, mild-to-moderate ulcerative colitis can achieve remission, including complete symptom resolution and mucosal healing, and remain relapse-free for at least 1 year with MMX mesalamine.
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