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Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?

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 end...

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Autores principales: Wetwittayakhlang, Panu, Lontai, Livia, Gonczi, Lorant, Golovics, Petra A., Hahn, Gustavo Drügg, Bessissow, Talat, Lakatos, Peter L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658443/
https://www.ncbi.nlm.nih.gov/pubmed/34884252
http://dx.doi.org/10.3390/jcm10235551
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author Wetwittayakhlang, Panu
Lontai, Livia
Gonczi, Lorant
Golovics, Petra A.
Hahn, Gustavo Drügg
Bessissow, Talat
Lakatos, Peter L.
author_facet Wetwittayakhlang, Panu
Lontai, Livia
Gonczi, Lorant
Golovics, Petra A.
Hahn, Gustavo Drügg
Bessissow, Talat
Lakatos, Peter L.
author_sort Wetwittayakhlang, Panu
collection PubMed
description 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.
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spelling pubmed-86584432021-12-10 Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology? Wetwittayakhlang, Panu Lontai, Livia Gonczi, Lorant Golovics, Petra A. Hahn, Gustavo Drügg Bessissow, Talat Lakatos, Peter L. J Clin Med Review 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. MDPI 2021-11-26 /pmc/articles/PMC8658443/ /pubmed/34884252 http://dx.doi.org/10.3390/jcm10235551 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Wetwittayakhlang, Panu
Lontai, Livia
Gonczi, Lorant
Golovics, Petra A.
Hahn, Gustavo Drügg
Bessissow, Talat
Lakatos, Peter L.
Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?
title Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?
title_full Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?
title_fullStr Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?
title_full_unstemmed Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?
title_short Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?
title_sort treatment targets in ulcerative colitis: is it time for all in, including histology?
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658443/
https://www.ncbi.nlm.nih.gov/pubmed/34884252
http://dx.doi.org/10.3390/jcm10235551
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