Brief Article
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World J Gastroenterol. Mar 21, 2014; 20(11): 2995-3001
Published online Mar 21, 2014. doi: 10.3748/wjg.v20.i11.2995
Frequency and prognostic role of mucosal healing in patients with Crohn’s disease and ulcerative colitis after one-year of biological therapy
Klaudia Farkas, Péter László Lakatos, Mónika Szűcs, Éva Pallagi-Kunstár, Anita Bálint, Ferenc Nagy, Zoltán Szepes, Noémi Vass, Lajos S Kiss, Tibor Wittmann, Tamás Molnár
Klaudia Farkas, Éva Pallagi-Kunstár, Anita Bálint, Ferenc Nagy, Zoltán Szepes, Noémi Vass, Tibor Wittmann, Tamás Molnár, First Department of Medicine, University of Szeged, H6720 Szeged, Hungary
Péter László Lakatos, Lajos S Kiss, First Department of Medicine, Semmelweis University, H1088 Budapest, Hungary
Mónika Szűcs, Department of Medical Physics and Informatics, University of Szeged, H6720 Szeged, Hungary
Noémi Vass, Faculty of Medicine, Pediatrics Department, University of Szeged, H6720 Szeged, Hungary
Author contributions: Molnar T, Farkas K and Wittmann T contributed to supervision of patient selection; Molnar T, Farkas K and Lakatos PL contributed to study design and statistical analysis; Molnar T, Farkas K, Lakatos PL, Nagy F, Szepes Z, Vass N, Kiss LS, Bálint A, Pallagi-Kunstár É contributed to data collection and manuscript preparation; all authors have approved the final draft submitted.
Supported by TAMOP-4.2.2.A-11/1/KONV-2012-0035, TAMOP-4.2.2-A-11/1/KONV-2012-0052 TAMOP-4.2.2.A-11/1/KONV-2012-0073; and OTKA Research Proposal PD 105948 (PI: Klaudia Farkas)
Correspondence to: Tamás Molnár, MD, PhD, First Department of Medicine, University of Szeged, Korányi fasor 8-10, H6720 Szeged, Hungary. molnar.tamas@med.u-szeged.hu
Telephone: +36-62-545186 Fax: +36-62-545185
Received: July 21, 2013
Revised: September 28, 2013
Accepted: November 2, 2013
Published online: March 21, 2014
Processing time: 239 Days and 19.3 Hours
Abstract

AIM: To assess the endoscopic activity before and after a one-year period of biological therapy and to evaluate the frequency of relapses and need for retreatment after stopping the biologicals in patients with Crohn’s disease (CD) and ulcerative colitis (UC).

METHODS: The data from 41 patients with CD and 22 patients with UC were assessed. Twenty-four CD patients received infliximab, and 17 received adalimumab. The endoscopic severity of CD was quantified with the simplified endoscopic activity score for Crohn’s disease in CD and with the Mayo endoscopic subscore in UC.

RESULTS: Mucosal healing was achieved in 23 CD and 7 UC patients. Biological therapy had to be restarted in 78% of patients achieving complete mucosal healing with CD and in 100% of patients with UC. Neither clinical remission nor mucosal healing was associated with the time to restarting the biological therapy in either CD or UC.

CONCLUSION: Mucosal healing did not predict sustained clinical remission in patients in whom the biological therapies had been stopped.

Keywords: Crohn’s disease; Ulcerative colitis; Biological therapy; Endoscopy; Mucosal healing

Core tip: Mucosal healing has become a subject of renewed interest, as tumor necrosis factor-α blockers have proven their efficacy in inducing and maintaining clinical and endoscopic remission. In this study, mucosal healing was observed in 56% and 32% of Crohn’s disease (CD) and ulcerative colitis (UC) patients. Retreatment with biological therapies was required in 78% of CD patients and in 100% of UC patients, despite achieving mucosal healing within 12 mo. Our results showed that mucosal healing after 12 mo of treatment was not associated with sustained clinical remission.