P098 An endoscopic therapeutic goal to maintain remission with tacrolimus in refractory ulcerative colitis
A. Ito*, T. Kuriyama, T. Omori, M. Yonezawa, N. Iizuka, K. Shiratori
Tokyo Women’s Medical University, Department of Gastroenterology, Tokyo, Japan
Tacrolimus (TAC) is effective as remission induction therapy for refractory ulcerative colitis (UC). Although the drug is principally administered for 3 months, no therapeutic goal to maintain remission has been established. Thus, to explore this goal, we divided patients into two groups: one group of patients who achieved remission maintenance (remission maintenance group), and another group who showed relapse (relapse group) after remission induction with TAC.
The subjects were divided into the remission maintenance or relapse group. In the groups, the sex, age at disease onset, disease extent, disease duration, pre-TAC CAI (Lichtiger score), Hb, CRP, total amount of PSL until remission, admission period, TAC administration period, post-TAC CAI, Hb, and CRP, and endoscopic score (Mayo score 1 or lower versus 2 or higher) were examined. Relapse was defined as CAI at 4 weeks post-TAC and thereafter being 4 or lower. Subjects with relapse were defined as those who required an intensive intravenous regimen of PSL, switching to a biological product, repeated TAC administration, or repeated remission induction at an increased dose to achieve a higher blood trough level (10 ng/dL or higher).
Between the two groups, no significant difference was noted in the sex, age at disease onset, disease extent, disease duration, pre-TAC CAI, Hb, or CRP, total amount of PSL until remission, admission period, TAC administration period (257 ± 178 and 174 ± 96 days for the remission maintenance and relapse groups, respectively), or post-TAC CAI, Hb, or CRP, whereas a significant difference was observed in the post-TAC endoscopic scores (P < 0.05). Adverse reactions including nephropathy (6 patients), tremor (5), and headache (2) occurred, but no significant reaction was noted.
The therapeutic goal to maintain remission with TAC treatment may be an endoscopic Mayo score of 1 or lower. Thus, in patients with a Mayo score of 2 or higher who showed clinical remission induction but persistent endoscopic inflammation, TAC should be continued to achieve a Mayo score of 1 or lower. Additionally, in patients who cannot achieve a Mayo score of 1 or lower in spite of continuous TAC, it is necessary to consider additional therapy or a change in therapy. In treatment with TAC, a goal to maintain remission may be the achievement of an endoscopic Mayo score of 1 or lower.