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P131. Systematic analysis of factors associated with progression and regression of ulcerative colitis in the Swiss IBD Cohort study

E. Safroneeva1, S. Vavricka2, N. Fournier3,4, F. Seibold5, C. Mottet6, A. Straumann7, G. Rogler2, A. Schoepfer6, 1University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 2University of Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 3Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Lausanne, Switzerland, 4University of Lausanne, IUMSP, Lausanne, Switzerland, 5University Hospital Bern, Gastroenterology and Hepatology, Bern, Switzerland, 6University of Lausanne, Gastroenterology and Hepatology, Lausanne, Switzerland, 7University of Basel, Gastroenterology and Hepatology, Basel, Switzerland

Background

There is a lack of studies having systematically assessed in a large cohort of patients with ulcerative colitis (UC) the disease location over time as well as risk factors associated with progression or regression of disease extent. We aimed to assess disease location over time and to evaluate associated risk factors.

Methods

Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (68%), regional hospitals (14%), and private practices (18%). Disease locations over time were analyzed and risk factor analysis for a change in disease location was performed using logistic regression modeling. Non parametric data are illustrated as median and interquartile range [IQR].

Results

A total of 1,016 UC patients (45.6% females, median age at diagnosis 31 [23.3–40.5] years) were included. At diagnosis, UC patients presented with the following disease locations: 199 (19.6%) proctitis, 338 (33.3%) left sided colitis, 381 (37.5%) extensive colitis/pancolitis, and 98 (9.6%) unknown. During a median of 9 [5–16] years disease duration, a disease progression was documented in 145/1016 (14.3%) of patients, a regression in 176/1016 (17.3%) of patients, whereas 624/1016 (61.4%) of patients had a stable disease location (7% of patients with unknown evolution of disease location over time). Logistic regression modeling identified the following factors associated with disease progression in UC patients presenting with proctitis or left-sided UC at diagnosis: treatment with systemic steroids (OR 2.077, 95%-CI 1.359–3.174, p = 0.001), treatment with immunomodulators (azathioprine, 6-MP, methotrexate) (OR 1.647, 95%-CI 1.119–2.424, p = 0.011), treatment with TNF-antagonist(s) (OR 1.668, 95%-CI 1.077–2.581, p = 0.022), and treatment with calcineurin-inhibitors (OR 3.159, 95%-CI 1.679–5.943, p < 0.001). Neither gender, age at UC diagnosis, body mass index, presence of extraintestinal manifestations, smoking status at diagnosis, positive UC family history, nor 5-ASA treatment were associated with disease progression. No specific factors were found to be associated with regression in UC patients with extensive colitis/pancolitis or left-sided colitis at diagnosis.

Conclusion

Over a median of 9 years disease duration about two thirds of UC patients maintained the initial disease location whereas one third either had a progression or a regression of the initial disease location. Treatment with systemic steroids, immunomodulators, TNF-antagonists, or calcineurin-inhibitors was significantly associated with disease progression.