One-year dynamics of clinical activity during biologics therapy in patients of ulcerative colitis
Yizhe Tie1, Fengyuan Su1,2, Jianwu Zhang3
1Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Background:
Longitudinal trajectories and the optimal timing for evaluating clinical activity remains unclear in ulcerative colitis (UC) patients receiving biologics.
Methods:
This study included 2705 UC patients from 5 trials and collected 28 807 records of partial Mayo scores (PMS) from baseline to week 52. Latent class growth mixed model was performed to construct 1-year PMS trajectories. Logistic regression assessed the association between PMS trajectories and 1-year therapeutic outcomes, and endoscopic remission was the primary outcome. Spearman correlation was utilized to identify the timepoints of PMS most correlated with the trajectories.
Results:
Five trajectories of clinical activity were identified, including rapid remission (n = 590, 21.8%), delayed remission (n = 316, 11.7%), mild improvement (n = 748, 27.7%), slow improvement (n = 915, 33.8%), and relapse-fluctuation (n = 136, 5.0%) groups. Endoscopic and histological remission rates exhibited a progressive decline across trajectory groups, with the highest probability in the rapid remission group and sequentially lower probabilities in the delayed remission, mild/slow improvement, and relapse-fluctuation groups (P < .001). Week-20 PMS demonstrated the strongest correlation with clinical activity trajectories (correlation coefficient = 0.7867, P < .001), with an area under curve of 0.9311 (95% CI: 0.9183, 0.9440). Furthermore, week-20 PMS could independently predicted 1-year endoscopic (aOR [95% CI] 0.59 [0.54, 0.65], P < .001) and histological (aOR [95% CI] 0.61 [0.53-0.70], P < .001) remission.
Conclusions:
UC patients receiving biologics would exhibit 5 distinct trajectories of clinical activity. Week 20 is a potential intermediate timepoint for clinical activity assessment to inform long-term outcomes.
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Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
