Disease Clearance in Ulcerative Colitis: A Narrative Review

Ulcerative colitis (UC) is a chronic relapsing disease with significant associated risks such as colectomy, hospitalization, or colorectal cancer. A treat-to-target approach that mitigates disease activity and progression from an early stage is needed. The latest STRIDE II guidelines advocate for clinical and endoscopic remission as the main therapeutic targets in the management of UC; however, histological remission is increasingly being recognized as an important outcome. The concept of disease clearance, a composite outcome comprising clinical, endoscopic, and histological remission, has been proposed as a potential target for patients with UC and has been precisely defined by the International Organization for the Study of Inflammatory Bowel Disease, with the aim of standardizing its use in clinical practice and research. Despite challenges, including variable standardized definitions and uncertainties regarding the timing of reaching different definitions of remission, disease clearance corresponds to comprehensive disease control, and its use as an outcome could help clinicians to better evaluate the actual status of the disease. Furthermore, achieving disease clearance may be related to an improved disease course, positive long-term outcomes, and an improvement in health-related quality of life. Real-world evidence supports the feasibility of achieving disease clearance with various treatment modalities, including vedolizumab, the only gut-selective antilymphocyte trafficking drug. The aim of this narrative review is to explore the concept of disease clearance in patients with disease clearance, mainly focusing on trials evaluating vedolizumab but also other biologics.