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- Original Article The predictive variable regarding relapse in patients with ulcerative colitis after achieving endoscopic mucosal healing
- Takuya Yoshino, Kohei Yamakawa, Satoshi Nishimura, Koutaro Watanabe, Shujiro Yazumi
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Intestinal Research 2016;14(1):37-42.
DOI: https://doi.org/10.5217/ir.2016.14.1.37
Published online: January 26, 2016
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- Correspondence to Shujiro Yazumi, Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan. Tel: +81-6-6312-1221, Fax: +81-6-6361-0588, s-yazumi@kitano-hp.or.jp
• Received: July 22, 2015 • Revised: October 14, 2015 • Accepted: October 16, 2015
© Copyright 2016. Korean Association for the Study of Intestinal Diseases. All rights reserved.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
-
Background/Aims
- Mucosal healing (MH) is a proposed therapeutic goal for patients with ulcerative colitis (UC). Whether MH is the final goal for UC, however, remains under debate. Therefore, to elucidate clinical variables predicting relapse after MH in UC could be useful for establishing further therapeutic strategy. The aim of this study is to evaluate the predictive variables for relapse in UC-patients after achieving MH.
-
Methods
- From April 2010 to February 2015, 298 UC-patients treated at Kitano Hospital were retrospectively analyzed. MH was defined as Mayo endoscopic subscore of 0 or 1. The cumulative relapse free rate after achieving MH was evaluated. Predictive variables for relapse in UC-patients were assessed by Cox regression analysis.
-
Results
- Of 298 UC-patients, 88 (29.5%) achieved MH. Of the 88 UC patients who achieved MH, 21 (23.9%) experienced UC-relapse. Based on Kaplan-Meier analysis, the cumulative relapse free rate at 1, 3, and 5 years after achieving MH was 87.9%, 70.2%, and 63.8%, respectively. The cumulative relapse free rate tended to be higher in the Mayo-0 group (76.9%) than in the Mayo-1 group (54.1%) at 5 years, although the difference was not statistically significant (P=0.313). Cox regression analysis indicated that the use of an immunomodulator was a predictive variable for relapse in UC-patients after achieving MH (P=0.035).
-
Conclusions
- Our data demonstrated that the prognosis of UC patients after achieving endoscopic MH could be based on UC refractoriness requiring an immunomodulator.
INTRODUCTION
METHODS
RESULTS
DISCUSSION
-
Financial support: This work was supported by the Japan Society for the Promotion of Science (JSPS) Grants-in-aid for Scientific Research [25860532 to T.Y].
-
Conflict of interest: None.
NOTES
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REFERENCES
Fig. 1
Cumulative relapse free rate of UC patients after achieving mucosal healing. Based on Kaplan-Meier analysis, the cumulative relapse free rate at 1, 3 and 5 years of UC patients after achieving mucosal healing were 87.9%, 70.2% and 63.8%, respectively.
Fig. 2
Cumulative relapse free rate between the Mayo-0 and Mayo-1 group. The cumulative relapse free rate of the Mayo-0 group was estimated as 76.9% at 5 years after achieving mucosal healing (solid line), and that of the Mayo-1 group was estimated as 54.1%. There was no significant difference of cumulative relapse free rate between the Mayo-0 and Mayo-1 group (P=0.313).
Table 1
![ir-14-37-i001.jpg]()
Patient's Characteristics
Table 2
![ir-14-37-i002.jpg]()
Patient's Characteristics Between Mayo-0 and Mayo-1 Group
Values are presented as n (%).
Categorical and continuous data were compared using a two-tailed Fisher exact test, Chi-squared test and Mann-Whitney U test.
M, male; F, female; 5-ASA, 5-aminosalicylic acid; AZA/6MP, Azathioprine/6-mercaptopurine; GMAA, granulocyte monocyte adsorption apheresis; TNF, tumor necrosis factor; N/A, not applicable.
Table 3
![ir-14-37-i003.jpg]()
Patient's Characteristics Between Non-Relapse and Relapse Group
Values are presented as n (%).
Categorical and continuous data were compared using a two-tailed Fisher exact test, Chi-squared test and Mann-Whitney U test.
M, male; F, female; 5-ASA, 5-aminosalicylic acid; AZA/6MP, Azathioprine/6-mercaptopurine; GMAA, granulocyte monocyte adsorption apheresis; TNF, tumor necrosis factor.
Figure & Data
REFERENCES
Citations
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The predictive variable regarding relapse in patients with ulcerative colitis after achieving endoscopic mucosal healing
Fig. 1 Cumulative relapse free rate of UC patients after achieving mucosal healing. Based on Kaplan-Meier analysis, the cumulative relapse free rate at 1, 3 and 5 years of UC patients after achieving mucosal healing were 87.9%, 70.2% and 63.8%, respectively.
Fig. 2 Cumulative relapse free rate between the Mayo-0 and Mayo-1 group. The cumulative relapse free rate of the Mayo-0 group was estimated as 76.9% at 5 years after achieving mucosal healing (solid line), and that of the Mayo-1 group was estimated as 54.1%. There was no significant difference of cumulative relapse free rate between the Mayo-0 and Mayo-1 group (P=0.313).
Fig. 1
Fig. 2
The predictive variable regarding relapse in patients with ulcerative colitis after achieving endoscopic mucosal healing
Patient's Characteristics
| Variable | n=88 |
|---|---|
| Gender (M/F) | 45/43 |
| Age at diagnosis (yr) (Median) | 34 (10–75) |
| Extent of disease | |
| Extensive colitis | 32 (36.4) |
| Left-sided | 21 (23.9) |
| Proctitis | 34 (38.6) |
| Unclear | 1 (1.1) |
| Endoscopic Mayo score | |
| Mayo-0 | 43 (48.9) |
| Mayo-1 | 45 (51.1) |
| Maintenance therapy | |
| 5-ASA | 72 (81.8) |
| AZA/6MP | 12 (13.6) |
| GMAA | 1 (1.1) |
| TNF-α antagonists | 6 (6.8) |
| None | 8 (9.1) |
| History of treatment with corticosteroid | 23 (26.1) |
| Corticosteroid refractory | 4 (4.5) |
| Corticosteroid dependent | 6 (6.8) |
Values are presented as n (%).
M, male; F, female; 5-ASA, 5-aminosalicylic acid; AZA/6MP, Azathioprine/6-mercaptopurine; GMAA, granulocyte monocyte adsorption apheresis; TNF, tumor necrosis factor.
Patient's Characteristics Between Mayo-0 and Mayo-1 Group
| Variable | Mayo-0 n=43 | Mayo-1 n=45 | P-value |
|---|---|---|---|
| Gender (M/F) | 23/20 | 22/23 | 0.666 |
| Age at diagnosis (yr), median (range) | 34 (15–75) | 34 (10–71) | 0.333 |
| Extent of disease | 0.361 | ||
| Extensive colitis | 17 (39.5) | 15 (33.3) | |
| Left-sided | 6 (14.0) | 15 (33.3) | |
| Proctitis | 19 (44.2) | 15 (33.3) | |
| Unclear | 1 (2.3) | 0 (0) | |
| Maintenance therapy | |||
| 5-ASA | 35 (81.4) | 37 (82.2) | 0.860 |
| AZA/6MP | 5 (11.6) | 7 (15.6) | 0.821 |
| GMAA | 0 (0) | 1 (2.2) | N/A |
| TNF-α antagonists | 1 (2.3) | 5 (11.1) | N/A |
| None | 5 (11.6) | 3 (6.7) | N/A |
| History of treatment with corticosteroid | 9 (20.9) | 14 (31.1) | 0.399 |
| Corticosteroid refractory | 2 (4.7) | 2 (4.4) | N/A |
| Corticosteroid dependent | 2 (4.7) | 4 (8.9) | N/A |
Values are presented as n (%).
Categorical and continuous data were compared using a two-tailed Fisher exact test, Chi-squared test and Mann-Whitney U test.
M, male; F, female; 5-ASA, 5-aminosalicylic acid; AZA/6MP, Azathioprine/6-mercaptopurine; GMAA, granulocyte monocyte adsorption apheresis; TNF, tumor necrosis factor; N/A, not applicable.
Patient's Characteristics Between Non-Relapse and Relapse Group
| Variable | non-Relapse n=67 | Relapse n=21 | P-value |
|---|---|---|---|
| Gender (M/F) | 34/23 | 11/10 | 0.564 |
| Age at diagnosis (yr), median (range) | 33 (10–75) | 35 (15–71) | 0.169 |
| Extent of disease | 0.265 | ||
| Extensive colitis | 21 (31.3) | 11 (52.4) | |
| Left-sided | 15 (22.4) | 6 (28.6) | |
| Proctitis | 30 (44.8) | 4 (19.0) | |
| Unclear | 1 (1.5) | 0 (0) | |
| Endoscopic Mayo score | 0.167 | ||
| Mayo-0 | 36 (53.7) | 7 (33.3) | |
| Mayo-1 | 31 (46.3) | 14 (66.7) | |
| Maintenance therapy | |||
| 5-ASA | 53 (79.1) | 19 (90.5) | 0.338 |
| AZA/6MP | 6 (9.0) | 6 (28.6) | 0.055 |
| GMAA | 1 (1.5) | 0 (0) | 1.000 |
| TNF-α antagonist | 3 (4.5) | 3 (14.3) | 0.145 |
| None | 6 (9.0) | 2 (9.5) | 1.000 |
| History of treatment with corticosteroid | 17 (25.4) | 6 (28.6) | 0.995 |
| Corticosteroid refractory | 3 (4.5) | 1 (4.8) | 1.000 |
| Corticosteroid dependent | 4 (6.0) | 2 (9.5) | 0.626 |
Values are presented as n (%).
Categorical and continuous data were compared using a two-tailed Fisher exact test, Chi-squared test and Mann-Whitney U test.
M, male; F, female; 5-ASA, 5-aminosalicylic acid; AZA/6MP, Azathioprine/6-mercaptopurine; GMAA, granulocyte monocyte adsorption apheresis; TNF, tumor necrosis factor.
The Multivariate Analyze of the Time to Relapse in UC Patients after Achieving Endoscopic mucosal healing
| Variable | HR | P-value | 95% CI | |
|---|---|---|---|---|
| Extensive colitis | 1.647 | 0.343 | 0.587 | 4.621 |
| Mayo-1 | 1.687 | 0.279 | 0.654 | 4.353 |
| Immunomodulator use | 6.134 | 0.035 | 1.134 | 33.17 |
HR, hazard ratio.
Table 1 Patient's Characteristics
Values are presented as n (%). M, male; F, female; 5-ASA, 5-aminosalicylic acid; AZA/6MP, Azathioprine/6-mercaptopurine; GMAA, granulocyte monocyte adsorption apheresis; TNF, tumor necrosis factor.
Table 2 Patient's Characteristics Between Mayo-0 and Mayo-1 Group
Values are presented as n (%). Categorical and continuous data were compared using a two-tailed Fisher exact test, Chi-squared test and Mann-Whitney M, male; F, female; 5-ASA, 5-aminosalicylic acid; AZA/6MP, Azathioprine/6-mercaptopurine; GMAA, granulocyte monocyte adsorption apheresis; TNF, tumor necrosis factor; N/A, not applicable.
Table 3 Patient's Characteristics Between Non-Relapse and Relapse Group
Values are presented as n (%). Categorical and continuous data were compared using a two-tailed Fisher exact test, Chi-squared test and Mann-Whitney M, male; F, female; 5-ASA, 5-aminosalicylic acid; AZA/6MP, Azathioprine/6-mercaptopurine; GMAA, granulocyte monocyte adsorption apheresis; TNF, tumor necrosis factor.
Table 4 The Multivariate Analyze of the Time to Relapse in UC Patients after Achieving Endoscopic mucosal healing
HR, hazard ratio.
