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Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?
Panu Wetwittayakhlang1,2, Livia Lontai3, Lorant Gonczi3
1Division of Gastroenterology, McGill University Health Center, Montreal, QC H3G 1A4, Canada.
Abstract:
The main therapeutic goal of ulcerative colitis (UC) is to induce and maintain remission to prevent long-term disease progression. Treat-to-target strategies, first introduced by the STRIDE consensus and updated in 2021, have shifted focus from symptomatic control toward more stringent objective endpoints. Today, patient monitoring should be based on a combination of biomarkers and clinical scores, while patient-reported outcomes could be used as short-term targets in monitoring disease activity and therapeutic response. In addition, endoscopic healing was the preferred long-term goal in UC. A Mayo endoscopic score (MES) ≤ 1 can be recommended as a minimum target. However, recent evidence suggests that more stringent endoscopic goals (MES of 0) are associated with superior outcomes. Recently, emerging data support that histological remission (HR) is a superior prognostic factor to endoscopic healing in predicting long-term remission. Despite not yet being recommended as a target, HR may become an important potential therapeutic goal in UC. However, it remains questionable if histological healing should be used as a routine assessment in addition to clinical, biomarker, and endoscopic targets in all patients. Therefore, in this review, our aim was to discuss the current evidence for the different treatment targets and their value in everyday clinical practice.
Insights
Treat-to-target strategies for ulcerative colitis (UC) now emphasize objective endpoints like biomarkers and endoscopic healing. Histological remission shows promise as a superior predictor of long-term outcomes, potentially becoming a future UC treatment goal.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Therapeutics
Background:
- Ulcerative colitis (UC) management aims to induce and maintain remission, preventing disease progression.
- Treat-to-target strategies, updated in 2021, prioritize objective endpoints over symptomatic control.
- Current monitoring combines biomarkers, clinical scores, and patient-reported outcomes for short-term assessment.
Purpose of the Study:
- To review current evidence on various treatment targets in ulcerative colitis.
- To evaluate the value of different therapeutic goals in clinical practice.
- To discuss the emerging role of histological remission in UC management.
Main Methods:
- Review of current literature on ulcerative colitis treatment targets.
- Analysis of data regarding clinical scores, biomarkers, patient-reported outcomes, endoscopic healing, and histological remission.
- Discussion of the prognostic value and clinical utility of different remission targets.
Main Results:
- Endoscopic healing (Mayo endoscopic score ≤ 1, preferably 0) is a key long-term goal in UC.
- Histological remission is emerging as a superior prognostic factor for long-term remission compared to endoscopic healing.
- The routine use of histological remission as a standard assessment in all UC patients requires further investigation.
Conclusions:
- Stringent objective endpoints, including endoscopic and potentially histological healing, are crucial for effective UC management.
- Histological remission holds significant promise as a future therapeutic target for predicting superior long-term outcomes in UC.
- Further research is needed to establish the role and routine implementation of histological remission in clinical practice for UC.
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