P-017 YI Mucosal Healing Is Associated with Improved Long-Term Outcomes in Ulcerative Colitis: A Systematic Review and Meta-analysis. (1st March 2016)

• Record Type: Journal Article
• Authors: Shah, Shailja; Colombel, Jean-Frédéric; Sands, Bruce; Narula, Neeraj
• Is Part Of: Inflammatory bowel diseases. Volume 22(2016:Mar.)Supplement 1
• Page Start: S14
• Page End: S14
• Publication Date: 2016-03-01
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000480063.58619.ad
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: The paradigm in ulcerative colitis (UC) is shifting away from treating to resolution of symptoms toward treating to more objective measures, including mucosal healing (MH). However, it is unclear if achieving MH is associated with sustained benefit and modification of natural disease course, as few studies have examined the direct impact of MH on long-term outcomes. We performed a systematic review and meta-analysis to identify and analyze studies comparing long-term outcomes in patients who achieve early MH compared to those who do not. Methods: A systematic literature search of PubMed, Embase, and Cochrane Library was performed to identify observational or interventional studies with a prospective cohort of clinically and endoscopically active UC patients that included long-term outcomes of patients who achieved MH compared to those who did not. The primary outcome was long-term clinical remission (CR). Secondary outcomes included long-term colectomy-free rate, MH rate, and corticosteroid (CS)-free CR rate. Pooled odds-ratios (OR) and 95% confidence intervals (CI) were calculated for each outcome. Results: Fourteen high quality studies with 2019 clinically and endoscopically active UC patients were eligible for inclusion in the meta-analysis. Patients who achieved early MH had a pooled OR of 4.88 [95% CI, 2.54–9.37] for achieving the primary outcome, long-term CR, 5.34 [95% CI, 2.92–9.76] for long-term colectomy-free rate, 8.40 [95% CI, 3.13–22.53] for long-term MH, and 9.70 [95% CI, 0.94–99.67] for long-term CS-free CR compared to patients who did not achieve MH. Sensitivity analyses suggested no significant difference in outcomes if MH was achieved on biologics compared to non-biologics. Conclusions: This meta-analysis of over 2000 active UC patients suggests that achieving MH, either with biologic or non-biologic therapy, is associated with improved long-term outcomes at 1 year and beyond. Based on our findings and in the absence of published prospective randomized control trials, it seems reasonable to target MH (in addition to clinical improvement) as a goal of UC treatment. Whether this strategy alters the natural disease course of UC or is favorable from a cost-effectiveness standpoint remains to be evaluated with well-designed prospective, clinical trials.