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Rate and Predictors of Mucosal Healing in Ulcerative Colitis Treated with Thiopurines: Results of a Multicentric Cohort Study

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Abstract

Background and Aims

Mucosal healing (MH) with thiopurines has been poorly investigated in ulcerative colitis (UC). We aimed to assess MH rate in UC patients treated with thiopurine monotherapy.

Patients and Methods

We retrospectively collected all UC patients treated with thiopurines more than 6 months who have undergone colonoscopy at baseline and after at least 6 months of treatment. Patients were recruited from January 2005 to May 2015 through a personal database and/or standardized hospital inpatient diagnostic dataset. Patients were excluded in case of any use of other immunomodulator or biological agent. MH was defined as a Mayo endoscopic subscore ≤1 and UCEIS ≤ 2. Histological healing (HH) was defined by the absence of epithelial polynuclear infiltrate, cryptic abscesses, or ulcerations.

Results

Eighty patients (31 women, median age 43 [IQR 32–58]) were included. Median disease duration was 10.5 [6–16] years. At baseline, median full Mayo score, endoscopic subscore, and UCEIS were 8 [6.8–10], 3 [2–3], and 5 [3–6], respectively. MH was first assessed after a mean follow-up of 38 ± 31 months. Median full Mayo score, endoscopic subscore, and UCEIS decreased to 3.5 [1–6], 2 [0–2.2], and 2 [0–4], respectively. MH was achieved in 43.7%, HH in 38%. In multivariate analysis, predictors of MH were thiopurine exposure duration ≥2 years [odds ratio (OR) 2.9, CI 95% (1.1–7.6), p = 0.03] and a prior acute severe colitis [OR 5.9, CI 95% (1.1–32), p = 0.04]. Factors associated with MH during treatment were partial Mayo score ≤2 (NPV = 100%), BMI ≥ 25 kg/m2 (NPV = 75%), and MCV ≥ 95 fL (NPV = 73%).

Conclusions

In UC, thiopurine monotherapy is associated with MH in 43.7% and HH in 38%.

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Abbreviations

UC:

Ulcerative colitis

MH:

Mucosal healing

HH:

Histological healing

SD:

Standard deviation

PPV:

Positive predictive value

NPV:

Negative predictive value

MCV:

Mean corpuscular volume

BMI:

Body mass index

IQR:

Interquartile range

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Author contributions

Caroline Prieux-Klotz contributed to study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis, and technical or material support. Stephane Nahon participated in study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and technical or material support. Aurélien Amiot involved in acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, statistical analysis, and technical or material support. Leila Sinayoko and Carole Galéano-Cassaz analyzed and interpreted the data. Stanislas Chaussade and Romain Coriat participated in critical revision of the manuscript for important intellectual content and technical or material support. Pierre Lahmek involved in statistical analysis. Vered Abitbol contributed to study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis, technical or material support, and study supervision.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Gastroenterology, Cochin Hospital AP-HP, 27, rue du Faubourg Saint Jacques PARIS, 75014, Paris, France

    Caroline Prieux-Klotz, Stanislas Chaussade, Romain Coriat & Vered Abitbol

  2. Division of Gastroenterology, GHI Le Raincy-Montfermeil, Montfermeil, France

    Stéphane Nahon

  3. Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA75-73, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France

    Aurelien Amiot

  4. Division of Gastroenterology, Begin Military Hospital, Saint-Mandé, France

    Leila Sinayoko

  5. Division of Gastroenterology, Val de Grace Military Hospital, Paris, France

    Carole Galéano-Cassaz

  6. Emile Roux Hospital AP-HP, Limeil-Brevannes, France

    Pierre Lahmek

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  1. Caroline Prieux-Klotz
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  2. Stéphane Nahon
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Correspondence to Caroline Prieux-Klotz.

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Prieux-Klotz, C., Nahon, S., Amiot, A. et al. Rate and Predictors of Mucosal Healing in Ulcerative Colitis Treated with Thiopurines: Results of a Multicentric Cohort Study. Dig Dis Sci 62, 473–480 (2017). https://doi.org/10.1007/s10620-016-4374-0

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