Complete normalization of mucosa and C-reactive protein (CRP) levels predicted risk for relapse in patients with ulcerative colitis (UC) who were in endo-histologic remission, according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.

Researchers conducted a retrospective cohort study at Tufts Medical University, identifying 128 patients in deep remission of UC. Patients demonstrated deep remission, exhibiting both endoscopic remission with Mayo Endoscopic Scores (MES) of 0 or 1 as well as histologic remission with a grade of 0 or 1 on the Nancy Histologic Index (NHI).

After a median of 10.5 years, 33% of the patients experienced a clinical relapse, while 66% stayed in remission. The investigators calculated the cumulative risk for UC relapse in these patients following deep remission to be 12.2% after 1 year and 23% after 3 years.


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Two factors significantly predicted risk for UC relapse — mucosal normalization and CRP levels. Factors such as age, gender, disease duration, follow-up length of time, and exposure to biological therapeutics did not predict risk for UC relapse.

Patients with completely normal mucosa as indicated by a NHI grade of 0, demonstrated decreased risk for relapse compared with patients who showed chronic architectural changes in the mucosa as indicated by a NHI grade of 1 (hazard ratio [HR], .35; P <.05).

CRP levels were available for only 36 of the 128 patients within 6 months prior to deep remission. Despite this small subgroup of patients, those with normalized CRP values of less than 7 mg/L demonstrated decreased risk for UC relapse after deep remission compared with patients whose CRP levels were elevated (HR, .41; P <.05).

“Further evaluation of CRP and depth of histologic remission at time of achieving endo-histologic remission, with complete normalization of mucosa and non-elevated CRP, may be the ideal clinical targets in [UC],” the presenters concluded.

Reference

Zeina T, Gandhi S, Mittal A, Levy A, Weinstock J, Jangi S. Predictors of clinical relapse among patients with ulcerative colitis in endo-histologic remission. Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Abstract Sa1561.