Relapse Half as Likely With Ulcerative Colitis in Clinical and Endoscopic Remission Than Clinical Remission with Mild Endoscopic Disease Activity

The current treatment target in ulcerative colitis (UC) is clinical and endoscopic remission, defined by patient-reported outcomes and a Mayo endoscopic subscore of 0 or 1. In this systemic review and meta-analysis of 17 studies and 2608 adult patients, the authors evaluated whether achievement of a subscore of 0 and histologic remission would result in lower annual clinical relapse rates.

The authors estimated that among patients with UC in clinical remission, those with endoscopically healed mucosa (defined as a Mayo endoscopic subscore of 0) were 52% less likely to experience a flare within 12 months compared to those with evidence of mild disease activity (Mayo endoscopic subscore 1; relative risk, 0.48; 95% confidence interval, 0.37–0.62). The annual rate of UC flare decreased from 29% (Mayo endoscopic subscore of 1) to 14% (Mayo endoscopic subscore of 0). When histologic remission was achieved, the risk of relapse further decreased to 5%. Since most studies included the meta-analysis–combined medications, the authors were unable to ascertain whether the magnitude of benefit may be different in patients treated with 5-aminosalicylic acid medications versus immunosuppressives, including biologics and targeted small molecule inhibitors.