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Zhang P, Zhang C, Chen B, He Y, Zeng Z, Mao R, Qiu Y, Chen M. Assessment of Endoscopy-Based Scoring Systems for Prognostication in Ulcerative Colitis: A Comparative Analysis. Dig Dis Sci 2024:10.1007/s10620-024-08582-8. [PMID: 39105877 DOI: 10.1007/s10620-024-08582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Endoscopy-based scoring systems, including Mayo Endoscopic Score (MES), Modified Mayo Endoscopic Score (MMES), and Degree of Ulcerative Colitis Burden of Luminal Inflammation (DUBLIN) Score, have been introduced to evaluate UC prognosis. This study aims to compare their predictive capacity for clinical outcomes in UC patients. METHODS Consecutive UC patients from a tertiary hospital were included. The primary outcome was acute severe ulcerative colitis (ASUC), and secondary outcomes were UC-related admission, medication treatment escalation, disease extension and surgery. Predictive performance was assessed using receiver operating characteristic (ROC) curves. RESULTS Among 300 patients, 15.3% developed ASUC. Robust correlations were observed among the three scoring systems and were with elevated serum inflammatory markers. The DUBLIN score exhibited superior predictive ability for UC-related admission (AUC 0.751; 95%CI 0.698-0.799) and medication treatment escalation (AUC 0.735; 95% CI 0.681-0.784). No statistical differences were found among three scoring systems for predicting ASUC, disease extension, and surgery. Employing respective cut-offs of 2, 11.25, and 3, higher MES (HR = 3.859, 95% CI 1.636-9.107, p = 0.002), MMES (HR = 3.352, 95% CI 1.879-5.980, p < 0.001), and DUBLIN score (HR = 5.619, 95% CI 2.378-13.277, p < 0.001) were associated with an increased risk of developing ASUC. CONCLUSION The DUBLIN score, assessing the overall inflammatory burden of the intestinal tract, outperforms the MMES in predicting admission and medication treatment escalation related to UC. Its integration into clinical practice has the potential to enhance risk stratification for patients with UC.
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Affiliation(s)
- Pingxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chuhan Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Baili Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yao He
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Zhirong Zeng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, People's Republic of China.
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, People's Republic of China
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Martins AL, Galhardi Gasparini R, Sassaki LY, Saad-Hossne R, Ritter AMV, Barreto TB, Marcolino T, Yang Santos C. Intestinal complications in Brazilian patients with ulcerative colitis treated with conventional therapy between 2011 and 2020. World J Gastroenterol 2023; 29:1330-1343. [PMID: 36925457 PMCID: PMC10011965 DOI: 10.3748/wjg.v29.i8.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/09/2022] [Accepted: 02/14/2023] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND This was an observational, descriptive, and retrospective study from 2011 to 2020 from the Department of Informatics of the Brazilian Healthcare System database.
AIM To describe the intestinal complications (IC) of patients with ulcerative colitis (UC) who started conventional therapies in Brazil´s public Healthcare system.
METHODS Patients ≥ 18 years of age who had at least one claim related to UC 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code and at least 2 claims for conventional therapies were included. IC was defined as at least one claim of: UC-related hospitalization, procedures code for rectum or intestinal surgeries, and/or associated disease defined by ICD-10 codes (malignant neoplasia of colon, stenosis, hemorrhage, ulcer and other rectum or anus disease, megacolon, functional diarrhea volvulus, intussusception and erythema nodosum). Descriptive statistics, annual incidence, and incidence rate (IR) [per 100 patient-years (PY)] over the available follow-up period were cal-culated.
RESULTS In total, 41229 UC patients were included (median age, 48 years; 65% women) and the median (interquartile range) follow-up period was 3.3 (1.8-5.3) years. Conventional therapy used during follow-up period included: mesalazine (87%), sulfasalazine (15%), azathioprine (16%) or methotrexate (1%) with a median duration of 1.9 (0.8-4.0) years. Overall IR of IC was 3.2 cases per 100 PY. Among the IC claims, 54% were related to associated diseases, 20% to procedures and 26% to hospitalizations. The overall annual incidence of IC was 2.9%, 2.6% and 2.5% in the first, second and third year after the first claim for therapy (index date), respectively. Over the first 3 years, the annual IR of UC-related hospitalizations ranged from 0.8% to 1.1%; associated diseases from 0.9% to 1.2% - in which anus or rectum disease, and malignant neoplasia of colon were the most frequently reported; and procedure events from 0.6% to 0.7%, being intestinal resection and polyp removal the most frequent ones.
CONCLUSION Study shows that UC patients under conventional therapy seem to present progression of disease developing some IC, which may have a negative impact on patients and the burden on the health system.
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Affiliation(s)
- Adalberta Lima Martins
- Espirito Santo Health Office, State Office for Pharmaceutical Assistance, Espirito Santos 29056-030, Brazil
| | | | - Ligia Yukie Sassaki
- Department of Gastroenterology, Sao Paulo State University, Medical School, Botucatu 18618-687, Brazil
| | - Rogerio Saad-Hossne
- Department of Gastroenterology, Sao Paulo State University, Medical School, Botucatu 18618-687, Brazil
| | | | - Tania Biatti Barreto
- Department of Gastroenterology, Takeda Pharmaceuticals Brazil, Sao Paulo 04794-000, Brazil
| | - Taciana Marcolino
- Department of Gastroenterology, Takeda Pharmaceuticals Brazil, Sao Paulo 04794-000, Brazil
| | - Claudia Yang Santos
- Department of Gastroenterology, Takeda Pharmaceuticals Brazil, Sao Paulo 04794-000, Brazil
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The CGRP/macrophage axis signal facilitates inflammation recovery in the intestine. Clin Immunol 2022; 245:109154. [DOI: 10.1016/j.clim.2022.109154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/20/2022]
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4
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Scharrer-Cabello S, Baeza-Zapata A, Herrera-Quiñones G, Luna-Limón C, Benavides-Salgado D. Stricturing ulcerative colitis: a case of rapid disease progression. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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5
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Scharrer-Cabello SI, Baeza-Zapata AA, Herrera-Quiñones G, Luna-Limón CG, Benavides-Salgado DE. Stricturing ulcerative colitis: a case of rapid disease progression. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2020; 85:491-493. [PMID: 33032840 DOI: 10.1016/j.rgmx.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/05/2019] [Accepted: 11/28/2019] [Indexed: 06/11/2023]
Affiliation(s)
- S I Scharrer-Cabello
- Departamento de Gastroenterología y Endoscopía, Hospital Universitario «Dr. José E. González», Monterrey, México.
| | - A A Baeza-Zapata
- Departamento de Gastroenterología y Endoscopía, Hospital Universitario «Dr. José E. González», Monterrey, México
| | - G Herrera-Quiñones
- Departamento de Gastroenterología y Endoscopía, Hospital Universitario «Dr. José E. González», Monterrey, México
| | - C G Luna-Limón
- Departamento de Patología Clínica, Hospital Universitario «Dr. José E. González», Monterrey, México
| | - D E Benavides-Salgado
- Departamento de Gastroenterología y Endoscopía, Hospital Universitario «Dr. José E. González», Monterrey, México
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Ochsenkühn T, Tillack C, Szokodi D, Janelidze S, Schnitzler F. Clinical outcomes with ustekinumab as rescue treatment in therapy-refractory or therapy-intolerant ulcerative colitis. United European Gastroenterol J 2019; 8:91-98. [PMID: 32213052 DOI: 10.1177/2050640619895361] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recently, ustekinumab a monoclonal antibody targeting interleukin-12 and -23 and successfully used in Crohn's disease also has been shown to be effective in induction and maintaining remission in patients with moderate to severe ulcerative colitis in a large phase 3 trial. However, no observational data on the use of ustekinumab in ulcerative colitis in daily clinical practice is available. AIM The purpose of this study was to assess the clinical outcomes achieved with ustekinumab as rescue treatment in therapy-refractory or -intolerant ulcerative colitis in a real-life setting. METHODS A retrospective data analysis was performed in 19 ulcerative colitis patients who were intolerant or refractory to all of the following drugs: steroids, purine-analogues, tumour necrosis factor antibodies and vedolizumab. To all patients ustekinumab was provided as a rescue treatment (intravenous induction with 6 mg/kg, followed by week subcutaneous injection once every eight weeks of 90 mg). The primary outcome was achievement of clinical remission at one year, defined as score of ≤ 3 points in the Lichtiger score (colitis activity index). Patients were evaluated regularly and a colonoscopy was performed before the start and at the end of the observation. Ethical approval was provided by Ethikkommission Ärztekammer Hamburg (PV 5539). RESULTS In five patients, therapy was stopped due to refractory disease or side effects. In all remaining 14 patients the median colitis activity index dropped from 8.5 points (range 1-12) at start to 2.0 points at one year (range 0-5.5) and Mayo endoscopy scores fell from a median of two points (range 1-3, mean of 2.3) at start to a median of one point (range 1-3, mean of 1.4) at one year. Including the five drop-outs, clinical remission was achieved in 53% of the 19 patients at one year. CONCLUSIONS In accordance with the UNIFI (A Study to Evaluate the Safety and Efficacy of Ustekinumab Induction and Maintenance Therapy in Participants With Moderately to Severely Active Ulcerative Colitis) trial our real-life data support ustekinumab as an effective and safe treatment option in therapy refractory moderate to severe ulcerative colitis with a history of biological therapies.
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Affiliation(s)
- Thomas Ochsenkühn
- IBD Center Munich, Munich, Germany.,Synesis IBD Research Center, Munich, Germany
| | - Cornelia Tillack
- IBD Center Munich, Munich, Germany.,Synesis IBD Research Center, Munich, Germany
| | - Daniel Szokodi
- IBD Center Munich, Munich, Germany.,Synesis IBD Research Center, Munich, Germany
| | - Shorena Janelidze
- IBD Center Munich, Munich, Germany.,Synesis IBD Research Center, Munich, Germany
| | - Fabian Schnitzler
- Synesis IBD Research Center, Munich, Germany.,Pasing Tagesklinik, Munich, Germany
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Mavroudis G, Magnusson MK, Isaksson S, Sundin J, Simrén M, Öhman L, Strid H. Mucosal and Systemic Immune Profiles Differ During Early and Late Phases of the Disease in Patients With Active Ulcerative Colitis. J Crohns Colitis 2019; 13:1450-1458. [PMID: 30946450 DOI: 10.1093/ecco-jcc/jjz072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Alterations in the immunopathogenesis in ulcerative colitis [UC] during the disease course have been proposed. We therefore aimed to determine mucosal and systemic immune profiles in individual patients at the time of diagnosis [early disease] and after 10 years [late disease]. METHODS Patients with UC provided serum and mucosal biopsies during a flare in early and in late disease. Serum samples were analysed using the Olink Proseek Inflammation panel. mRNA gene expression of biopsies was analysed using the Qiagen RT2 Profiler PCR Arrays Antibacterial response and T Helper Cell Differentiation. RESULTS Orthogonal projections to latent structures discriminant analyses [OPLS-DA] demonstrated that the profile of 15 serum proteins discriminated in early and late disease [R2 = 0.84, Q2 = 0.65] in 15 UC patients. Eight of these proteins were differently expressed between the groups [Q <0.05]. Further, OPLS-DA of the mRNA profiles in biopsies strongly discriminated early and late disease with high predictability [R2 = 0.96, Q2 = 0.89]; 42 genes were differently expressed at the two time points [Q <0.05]. Finally, principal component analysis showed that T helper [Th] 1- and Th2-related genes were associated with early disease and late disease, respectively, and hierarchical cluster analysis was able to cluster patients with early from late disease with only minor overlap. CONCLUSIONS Mucosal and systemic immune profiles differ between early and late disease in patients with active UC, with a transition from a Th1- to a Th2-driven disease in the intestine. Improved understanding of the variation in immunopathogenesis during the disease course in UC is important to guide individualised treatment decision making.
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Affiliation(s)
- Georgios Mavroudis
- Sahlgrenska University Hospital, Department of Internal Medicine, Gothenburg, Sweden.,Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden
| | - Maria K Magnusson
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Department of Microbiology and Immunology, Gothenburg, Sweden
| | - Stefan Isaksson
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Department of Microbiology and Immunology, Gothenburg, Sweden
| | - Johanna Sundin
- Sahlgrenska University Hospital, Department of Internal Medicine, Gothenburg, Sweden.,Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden
| | - Magnus Simrén
- Sahlgrenska University Hospital, Department of Internal Medicine, Gothenburg, Sweden.,Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden
| | - Lena Öhman
- Sahlgrenska University Hospital, Department of Internal Medicine, Gothenburg, Sweden.,Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Department of Microbiology and Immunology, Gothenburg, Sweden
| | - Hans Strid
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden.,Södra Älvsborg Hospital, Department of Internal Medicine, Borås, Sweden
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Marti-Aguado D, Ballester MP, Tosca J, Bosca-Watts MM, Navarro P, Anton R, Pascual I, Mora F, Minguez M. Long-term follow-up of patients treated with aminosalicylates for ulcerative colitis: Predictive factors of response: An observational case-control study. United European Gastroenterol J 2019; 7:1042-1050. [PMID: 31662861 PMCID: PMC6794696 DOI: 10.1177/2050640619854277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/05/2019] [Indexed: 01/19/2023] Open
Abstract
Background Knowing patients' ulcerative colitis history is essential to selecting the appropriate therapy according to risk stratification. Objective To evaluate and identify predictive factors of non-response to aminosalicylates judged as the need for a step-up approach over time. Methods A case-control study of ulcerative colitis patients treated with aminosalicylates after the diagnosis of disease flare included in the ENEIDA single-centre registry from 1997 to 2017. Long-term treatment maintenance with aminosalicylates and higher therapeutic requirements were recorded. The cumulative incidence of treatment escalation was estimated using Kaplan-Meier curves and compared by the log-rank test. Cox regression analysis was performed to identify predictive factors of treatment with immunomodulators, biological agents or surgery. Results A total of 457 patients were included, of whom 28% (n = 126) were non-responders to aminosalicylates. The cumulative probability for a step-up approach within 20 years of follow up was 35%, mainly due to steroid-dependent colitis. Risk factors for treatment escalation were age ≤27 years (hazard ratio 2.31, 95% confidence interval 1.36-3.92), extensive colitis (hazard ratio 1.65, 95% confidence interval 1.04-2.60), Mayo endoscopic subscore ≥2 (hazard ratio 1.45, 95% confidence interval 1.02-2.06) and extraintestinal manifestations (hazard ratio 2.04, 95% confidence interval 1.03-4.05). Conclusions Aminosalicylates represent an effective maintenance therapy. Younger age, extensive colitis, endoscopic disease severity and extraintestinal manifestations are risk factors for higher therapeutic requirements.
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Affiliation(s)
- David Marti-Aguado
- Digestive Disease Department, University
Clinic Hospital of Valencia, Valencia, Spain
| | - María Pilar Ballester
- Digestive Disease Department, University
Clinic Hospital of Valencia, Valencia, Spain
| | - Joan Tosca
- Digestive Disease Department, University
Clinic Hospital of Valencia, Valencia, Spain
| | | | - Pablo Navarro
- Digestive Disease Department, University
Clinic Hospital of Valencia, Valencia, Spain
| | - Rosario Anton
- Digestive Disease Department, University
Clinic Hospital of Valencia, Valencia, Spain
| | - Isabel Pascual
- Digestive Disease Department, University
Clinic Hospital of Valencia, Valencia, Spain
- University of Valencia, Valencia,
Spain
| | - Francisco Mora
- Digestive Disease Department, University
Clinic Hospital of Valencia, Valencia, Spain
- University of Valencia, Valencia,
Spain
| | - Miguel Minguez
- Digestive Disease Department, University
Clinic Hospital of Valencia, Valencia, Spain
- University of Valencia, Valencia,
Spain
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