P261 Clinical predictors of a frequently relapsing disease course under 5-ASA amongst ulcerative colitis patients initially responding to induction therapy with 5-ASA and/or steroids
K. Atay*, Y. Erzin, I. Hatemi, T. Eskazan, I. Serin, S. Bozcan, N. Demir, A. F. Celik
Istanbul University Cerrahpasa Medical School, Gastroenterology, Istanbul, Turkey
Aim of the study was to identify independent predictors of a frequently relapsing ulcerative colitis (UC) during maintenance treatment with 5-ASA after having initial clinical remission with 5-ASA and/or steroids
We retrospectively compared the clinical parameters of frequently relapsing UC patients with patients having quiescent disease course. Patients have been identified from our IBD clinic with 1115 registered UC patients. Patients never having a flare after induction of remission (Group1) at least within 2 years after the initial diagnosis were compared with frequently relapsing ones within the same period between 6 and 24 mo (Group2) regarding demographic features such as age, sex, age at diagnosis, disease extension, smoking status, family history, initial frequency of bowel movements, initial acute phase reactants, initial need of steroids for remission, and time to complete clinical remission. Patients having flares within the first 6 mo after the initiation of induction treatment were not included, as they might have been accepted as steroid dependent. According to our clinical policy, all UC patients having flares after 6 mo were treated with a step-up approach (AZA and/or anti-TNF) while keeping them on 5-ASA. Rate of short- and long-term colectomies in both groups were noted, as well.
In total, 104 (Group 1 = 40 and Group 2 = 64) patients diagnosed with UC were included. The mean follow-up time was 103.6 ± 49.6 mo. The mean age, sex, age at diagnosis, follow-up time, and frequency of concomitant diseases such as HT, DM, and HPL did not disclose any significant difference between both groups. At initial diagnosis patients with pancolitis, non-smoking status, positive family history, and needing steroids were significantly more common in Group 2, and in this group, initial CRP levels, stool frequency were significantly higher and time to remission significantly longer compared with Group 1 (Table 1). However, a linear regression analysis (r 2 = 0.514) disclosed initial WBC count (p = 0.001), time to remission (p = 0.027), and non-smoking status (p = 0.035) to be the only independent predictors of a worse disease course. The ROC curve identified a cut-off of 8650 WBC/ml to have a sensitivity of 78% and specificity of 80% and a cut-off for time to complete clinical remission of 2.5 mo to have a sensitivity of 83% and specificity of 63% for a relapsing disease course
The present study shows that in UC patients with successful induction treatment (with 5-ASA and/or steroids) after the initial diagnosis; being non-smoker, having WBC count above 8650/ml at initial presentation, and needing longer than 2.5 mo to achieve clinical remission, predict relapsing disease course and a higher percentage of colectomy rate.