Anemia, Need for Corticosteroids May Predict Complicated Disease Course in Ulcerative Colitis

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Researchers assessed clinical predictors for a complicated disease course in patients recently diagnosed with ulcerative colitis.

Anemia and previous use of corticosteroids are associated with a significantly higher risk for a complicated disease course in patients with ulcerative colitis (UC), investigators reported in the International Journal of Colorectal Disease.

The researchers sought to prospectively validate a number of clinical predictors for a complicated disease course in patients who were recently diagnosed with UC, concentrating on common variables that are assessable in everyday clinical practice.

The multicenter, observational EPICOL study included 311 patients with UC as the inception cohort (diagnosis, <6 months) and was conducted from March 2015 to April 2020. All patients were naive to immunosuppressants and biologics.

Univariate and multivariate Cox regression analyses were performed to analyze predictive factors for the need for immunosuppressants and/or biologic treatment (therapy with a tumor necrosis factor [TNF]-α antagonists) and/or hospitalization within 24 months.

The final cohort included 307 patients with UC. Mean patient age was 38.5 years, 44.6% (n=137) were women, and mean time since diagnosis was 1.9 months.

In the analysis cohort, 209 patients (68.1%) were neither hospitalized nor received immunosuppressive therapy and were regarded as having an uncomplicated disease course (group 1). The other 98 patients (31.9%) were classified as having a complicated disease course, requiring hospitalization and/or immunosuppressants and/or anti–TNF-α therapy (group 2).

In the group 2 patients, 56 (57.1%) were treated with anti-TNF-α therapy either with or without immunosuppressants, and 42/98 (42.9%) received immunosuppressive monotherapy with azathioprine.

Multivariate regression analysis in a final model showed that previous use of corticosteroids was associated with a 2.3-fold increased risk and anemia with a 1.9-fold increased risk for subsequent need for immunosuppressive therapy and/or hospitalization.

Based on the parameters of systemic corticosteroid use and anemia, the study authors developed a predictive risk model to determine a patient’s likelihood of having a complicated disease course at 6, 12, or 24 months.

The model showed that previous use of corticosteroids and/or presence of anemia increases the risk for immunosuppressive therapy after 6 months to >13%. The likelihood of a complicated disease course occurring after 12 and 24 months ranges from 21.9% after 12 months with anemia to 40.3% after 24 months with previous corticosteroid use and anemia.

The researchers noted that their study was conducted at centers that specialized in inflammatory bowel disease and patients treated by primary care physicians were not included in the analysis. Therefore, it is possible that different or additional predictors may be relevant in patients treated at centers with less therapeutic experience. Additionally, a number of measurements were not available in some cases.

“[T]his thoroughly designed, large, prospective inception cohort study of patients with UC determined clinical predictors that are easy to assess in everyday clinical practice and provided important evidence for the risk stratification of patients with recently diagnosed UC,” the investigators concluded.

Disclosure: The study was funded by AbbVie. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Schmidt C, Bokemeyer B, Lügering A, et al. Clinical predictors for a complicated course of disease in an inception cohort of patients with ulcerative colitis: results from the prospective, observational EPICOL study. Int J Colorectal Dis. 2022;37(2):485-493. doi: 10.1007/s00384-022-04098-7