DDW ePoster Library

INFLAMMATION ON INDEX BIOPSY PREDICTS LOSS OF REMISSION AMONG ULCERATIVE COLITIS PATIENTS WITH ENDOSCOPIC REMISSION: A US COHORT ANALYSIS
DDW ePoster Library. Click B. 05/22/22; 355012; Su1537
Benjamin Click
Benjamin Click
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Number: Su1537
INFLAMMATION ON INDEX BIOPSY PREDICTS LOSS OF REMISSION AMONG ULCERATIVE COLITIS PATIENTS WITH ENDOSCOPIC REMISSION: A US COHORT ANALYSIS

Society: AGA
Track: Inflammatory Bowel Diseases

Author(s): Benjamin Click1, Eric J Mao2, Harris Ahmad3, James B Canavan3, Ying Qiu3, Cindy Theigs4, Derek Gazis5, Janet S. Hildebrand5, Julie Mallory Crawford5, Millie Dascomb Long6

Institution(s): 1. Cleveland Clinic, Cleveland, OH, United States. 2. University of California Davis Health System, Sacramento, CA, United States. 3. Bristol Myers Squibb Co, Princeton, NJ, United States. 4. AbbVie Inc, North Chicago, IL, United States. 5. Target RWE, Durham, NC, United States. 6. University of North Carolina System, Chapel Hill, NC, United States.

Objective: Patients with ulcerative colitis (UC) who have previously responded to advanced therapies may experience loss of remission (LOR), although reasons for LOR remain unclear. We assessed the associations between clinical characteristics and subsequent LOR in a real-world US-based cohort of UC patients in corticosteroid-free endoscopic remission at baseline.
Methods: Corticosteroid-free adult UC patients in endoscopic remission on index colonoscopy (no evidence of endoscopic inflammation, erosions or ulceration), with an index histology assessment and known duration of disease, enrolled in TARGET-IBD from July 2017 to June 2021, were included. LOR was defined as the presence of endoscopic inflammation, erosion or ulceration on follow-up colonoscopy, or commencement of steroids. Multivariable Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of LOR in relation to age, duration of disease, disease location, previous and current use of biologics, and histologic inflammation assessed via biopsy at index. Follow-up time was calculated as days from the index colonoscopy to the earliest of: LOR, death, discontinuation from the study, IBD surgery, or end of available data.
Results: 513 UC patients were eligible for analysis (53.0% female; median age at diagnosis 31 years; median disease duration 10 years). (Table 1) Among these, 188 patients (36.6%) experienced LOR during follow-up. Median follow-up time was 21.3 months; among patients who experienced LOR, median time to LOR was 11.8 months (IQR 5.3 - 20.1 months). In the multivariable model, presence of histological inflammation on index biopsy was associated with greater risk of LOR (HR 2.01, 95% CI 1.50-2.69, compared to no inflammation); older age was associated with lower risk of LOR (HR 0.988, 95% CI 0.978-0.998). (Table 2) Results relating to inflammation on index biopsy were not modified by disease location, current biologic use, or number of previous biologics.
Conclusion: Among corticosteroid-free UC patients in endoscopic remission, histologic inflammation was associated with a two-fold increased risk of subsequent LOR, often within a year. Future research should focus on determining if treatment modification or intensification may be effective at preventing LOR in patients with risk factors.
Number: Su1537
INFLAMMATION ON INDEX BIOPSY PREDICTS LOSS OF REMISSION AMONG ULCERATIVE COLITIS PATIENTS WITH ENDOSCOPIC REMISSION: A US COHORT ANALYSIS

Society: AGA
Track: Inflammatory Bowel Diseases

Author(s): Benjamin Click1, Eric J Mao2, Harris Ahmad3, James B Canavan3, Ying Qiu3, Cindy Theigs4, Derek Gazis5, Janet S. Hildebrand5, Julie Mallory Crawford5, Millie Dascomb Long6

Institution(s): 1. Cleveland Clinic, Cleveland, OH, United States. 2. University of California Davis Health System, Sacramento, CA, United States. 3. Bristol Myers Squibb Co, Princeton, NJ, United States. 4. AbbVie Inc, North Chicago, IL, United States. 5. Target RWE, Durham, NC, United States. 6. University of North Carolina System, Chapel Hill, NC, United States.

Objective: Patients with ulcerative colitis (UC) who have previously responded to advanced therapies may experience loss of remission (LOR), although reasons for LOR remain unclear. We assessed the associations between clinical characteristics and subsequent LOR in a real-world US-based cohort of UC patients in corticosteroid-free endoscopic remission at baseline.
Methods: Corticosteroid-free adult UC patients in endoscopic remission on index colonoscopy (no evidence of endoscopic inflammation, erosions or ulceration), with an index histology assessment and known duration of disease, enrolled in TARGET-IBD from July 2017 to June 2021, were included. LOR was defined as the presence of endoscopic inflammation, erosion or ulceration on follow-up colonoscopy, or commencement of steroids. Multivariable Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of LOR in relation to age, duration of disease, disease location, previous and current use of biologics, and histologic inflammation assessed via biopsy at index. Follow-up time was calculated as days from the index colonoscopy to the earliest of: LOR, death, discontinuation from the study, IBD surgery, or end of available data.
Results: 513 UC patients were eligible for analysis (53.0% female; median age at diagnosis 31 years; median disease duration 10 years). (Table 1) Among these, 188 patients (36.6%) experienced LOR during follow-up. Median follow-up time was 21.3 months; among patients who experienced LOR, median time to LOR was 11.8 months (IQR 5.3 - 20.1 months). In the multivariable model, presence of histological inflammation on index biopsy was associated with greater risk of LOR (HR 2.01, 95% CI 1.50-2.69, compared to no inflammation); older age was associated with lower risk of LOR (HR 0.988, 95% CI 0.978-0.998). (Table 2) Results relating to inflammation on index biopsy were not modified by disease location, current biologic use, or number of previous biologics.
Conclusion: Among corticosteroid-free UC patients in endoscopic remission, histologic inflammation was associated with a two-fold increased risk of subsequent LOR, often within a year. Future research should focus on determining if treatment modification or intensification may be effective at preventing LOR in patients with risk factors.

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