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Endoscopic and clinical variables that predict sustained remission in children with ulcerative colitis treated with

Dan Turner1, Anne M Griffiths, Gigi Veerman

  • 1Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|May 16, 2013
PubMed

Insights

Early assessment using the Pediatric UC Activity Index (PUCAI) effectively predicts sustained remission in children with ulcerative colitis (UC) treated with infliximab. A low week 8 PUCAI score indicates a higher likelihood of long-term steroid-free remission.

Area of Science:

  • Pediatric Gastroenterology
  • Inflammatory Bowel Disease Research
  • Clinical Trial Analysis

Background:

  • Identifying predictors of sustained remission is crucial for optimizing treatment in pediatric ulcerative colitis (UC).
  • Infliximab is a key therapy for moderate-to-severe UC in children.
  • Early assessment factors need validation for predicting long-term outcomes.

Purpose of the Study:

  • To identify early clinical, laboratory, and endoscopic predictors of sustained remission in pediatric UC patients treated with infliximab.
  • To compare the predictive value of the Pediatric UC Activity Index (PUCAI), C-reactive protein (CRP), and mucosal healing for steroid-free remission.

Main Methods:

  • Post hoc analysis of 51 children (6-17 years) with moderate-to-severe UC from the T72 clinical trial.
  • Primary outcome: steroid-free remission at weeks 30 and 54, assessed by patients and physicians.
  • Comparison of week 8 PUCAI scores, CRP levels, and mucosal healing for predicting 1-year sustained remission.

Main Results:

  • Week 8 PUCAI scores (<10 points) were the strongest predictor of steroid-free remission at 1 year (53% vs 20%, P=.036).
  • Mucosal healing at week 8 showed a trend towards predicting remission (44% vs 29%, P=.34).
  • The week 8 PUCAI was the only significant factor in multivariable analysis (P=.038); CRP was not predictive.

Conclusions:

  • The Pediatric UC Activity Index (PUCAI) at week 8 is a reliable predictor of sustained remission in pediatric UC patients on infliximab.
  • PUCAI demonstrated superior predictive value compared to CRP levels and was comparable to mucosal healing.
  • Routine endoscopy may not be necessary for children achieving clinical remission (PUCAI <10) at week 8.
Abstract

Keywords:
AUROCC-reactive proteinCICRPIBDIQRMHPGAPUCAIPaGAPediatric UC Activity IndexPredicting Response to TherapyPrognosisROCUCconfidence intervalinterquartile rangemucosal healingpatient global assessmentphysician global assessmentreceiver operating characteristiculcerative colitis

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