Histological Severity Does Not Predict Extension of Ulcerative Colitis

Yansheng Hao, MD, PhD

The risk of endoscopic extension has established correlations with the clinical features of limited ulcerative colitis (UC), including early age of onset.

Approximately 30% of patients with limited ulcerative colitis extend to pancolitis and are at an increased risk of adverse clinical outcomes.

A team, led by Yansheng Hao, MD, PhD, Department of Pathology, Icahn School of Medicine at Mount Sinai, determined whether histologic features also correlate with disease extension.

The Study

In the study, the researchers examined 40 ulcerative colitis patients from a pair of large academic centers. Each patient was diagnosed between 2006-2017 with an endoscopically limited ulcerative colitis (Montreal E1 or E2) at baseline and greater than 2 subsequent endoscopic examinations with biopsies.

The severity of inflammation was scored using both the Mount Sinai Activity Index and Nancy Histological Index.

Each patient was divided into a cohort of patients who progressed to pancolitis (Montreal E3) and defined as “Extenders” (n = 21) or patients without progression in the follow-up period, who were defined as “Non-extenders” (n = 19).

The median follow-up time was 58.4 months.

Results

“The histologic scores in the endoscopically involved mucosa of the index biopsies were not associated with subsequent extension of disease, overall,” the authors wrote.

On the other hand, the index histology scores were associated with biopsy scores at extension (r = 0.455, P = 0.044) and index severity was associated with a shorter time to extension (r =− 0.611, P = 0.003) among the extender cohort.

Female patients also had a shorter time to extension (P = 0.013).

“Histological severity of limited UC is not an independent predictor of extension in UC,” the authors wrote. “However, among patients who subsequently extend, severe inflammation at baseline correlates with shorter progression time and severe inflammation when extension occurs. Patients with limited UC but severe histologic inflammation may warrant more frequent endoscopic surveillance.”

An Answer for Ulcerative Colitis

A recent study found that maintaining ulcerative colitis (UC) remission was significantly more common in patients who continued treatment with infliximab, compared to those who discontinued treatment.

The use of anti-tumor necrosis factor (TNF) agents is common in the treatment of refractory UC, but the long-term use of anti-TNF therapy can increase the risk of malignancy or infection.

No previous study trial has evaluated the safety of anti-TNF agent discontinuation in patients with UC in remission.

In the infliximab-continued group, 37 of 46 patients (80.4%) were in remission at week 48.

In the infliximab-discontinued group, 25 of 46 patients (54.3%) were in remission at week 48.

Adverse events were found in 8 (17%) patients in the infliximab-continued group, including a patient who experienced an infusion reaction. This is compared to 6 (13%) in the infliximab-discontinued group, with 2 patients experiencing psoriatic skin lesions.

The team stated that 8 of 12 patients in the infliximab-discontinuation group, who were then re-treated with infliximab after relapse were in remission in 8 weeks of new treatment. None had infusion reactions.

Investigators cautioned against the discontinuation of infliximab, stating patients should take the risks of relapse and efficacy of re-treatment into account before making the decision to discontinue.

The study, “Baseline Histological Findings Do Not Predict the Risk of Subsequent Extension in Patients with Limited Ulcerative Colitis,” was published online in Digestive Diseases and Sciences.