The predictive variable regarding relapse in patients with ulcerative colitis after achieving endoscopic mucosal healing

BACKGROUND/AIMS: Mucosal healing (MH) is a proposed therapeutic goal for patients with ulcerative colitis (UC). Whether MH is the final goal for UC, however, remains under debate. Therefore, to elucidate clinical variables predicting relapse after MH in UC could be useful for establishing further therapeutic strategy. The aim of this study is to evaluate the predictive variables for relapse in UC-patients after achieving MH. METHODS: From April 2010 to February 2015, 298 UC-patients treated at Kitano Hospital were retrospectively analyzed. MH was defined as Mayo endoscopic subscore of 0 or 1. The cumulative relapse free rate after achieving MH was evaluated. Predictive variables for relapse in UC-patients were assessed by Cox regression analysis. RESULTS: Of 298 UC-patients, 88 (29.5%) achieved MH. Of the 88 UC patients who achieved MH, 21 (23.9%) experienced UC-relapse. Based on Kaplan-Meier analysis, the cumulative relapse free rate at 1, 3, and 5 years after achieving MH was 87.9%, 70.2%, and 63.8%, respectively. The cumulative relapse free rate tended to be higher in the Mayo-0 group (76.9%) than in the Mayo-1 group (54.1%) at 5 years, although the difference was not statistically significant (P=0.313). Cox regression analysis indicated that the use of an immunomodulator was a predictive variable for relapse in UC-patients after achieving MH (P=0.035). CONCLUSIONS: Our data demonstrated that the prognosis of UC patients after achieving endoscopic MH could be based on UC refractoriness requiring an immunomodulator.