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P338 Rate and predictors of mucosal healing in patients with ulcerative colitis treated with thiopurines: results of a multicentric cohort study

C. Prieux-Klotz*1, S. Nahon2, A. Amiot3, L. Sinayoko4, C. Galéano-Cassaz5, S. Chaussade1, P. Lahmek6, V. Abitbol1

1C.H.U. Cochin, Paris, France, 2C.H. Le Raincy Montfermeil, Montfermeil, France, 3C.H.U. Henri Mondor, Créteil, France, 4H.I.A. Bégin, Saint Mandé, France, 5H.I.A. Val de Grâce, Paris, France, 6C.H. Emile Roux, Limeil-Brévannes, France

Background

Mucosal healing (MH) has become the optimal treatment goal in ulcerative colitis (UC). MH rate is little known in UC patients treated by thiopurines. Our study aimed to assess rate and predictors of MH in UC patients treated with thiopurine monotherapy.

Methods

Five hospitals participated in this retrospective study. Patients were selected from prospective and administrative databases. Inclusion criteria were UC, thiopurine monotherapy longer than 6 months and endoscopic evaluation before (T0), and at least 6 months after treatment initiation (T1). Exclusion criteria were associated anti-TNF alpha, methotrexate or ciclosporin intake.

Baseline characteristics of the patients (age at diagnosis, Montreal classification, complications) were collected in a standardised anonymous questionnaire (File Maker Pro v.12®). Clinical (Mayo score), biology, and endoscopic (Mayo score, Ulcerative Colitis Endoscopic Index of Severity [UCEIS]) data were collected at T0, T1, and at latest news (T2). MH definition was: Mayo endoscopic score ≤ 1 or UCEIS ≤ 2. Results were reported in medians (Q1–Q3). Patients with and without MH were compared by Mann–Whitney–Wilcoxon test for non-parametric quantitative variables and by Student t-test for parametric variables.

Results

Out of 902 UC patients, 125 received at least 6 months of thiopurine monotherapy: 45 were excluded because previous ciclosporin treatment for acute severe colitis (n = 9) or lack of endoscopic evaluation (n = 36). In total, 80 patients were included (aged 43 [32–58], 31 women). UC duration was 10.5 (6–16) years. UC extent was E1, E2, and E3 in 8 (10%), 33 (42.5%), and 37 (47.5%) patients, respectively. At T0, global Mayo score, endoscopic Mayo score, and UCEIS were 8 (6.75–10), 3 (2–3), and 5 (3–6), respectively. At T1, after 26 (11–56) months of thiopurine intake, global Mayo score, endoscopic Mayo score, and UCEIS were 3.5 (1–6), 2 (0–2.25), and 2 (0–4), respectively. Clinical remission was achieved in 62.7%; MH in 43.7%; and histologic healing in 38%. At T0, independent predictive factors of MH were thiopurine exposure ≥ 2 years (p = 0.05) and an acute severe colitis before thiopurine (p = 0.03). At T1, factors associated with MH were clinical Mayo score ≤ 2 (NPV = 100%), rectal bleeding Mayo sub-score ≤ 1 (NPV = 100%), BMI ≥ 25Kg/m2 (NPV = 75%), and MCV ≥ 95fL (NPV = 73%). At T2 (n = 49), after 5.9 (3.4–9.5)-years follow-up, 79% achieved clinical remission and 63.2% MH. At T2, 80% of the patients who achieved MH at T1 were still healed.

Conclusion

In this multicentric retrospective study in UC, 43.7% of patients treated with thiopurine monotherapy achieved MH. Independent predictive factors of MH were exposure to thiopurine ≥ 2 years and severe acute colitis before thiopurine. Absence of rectal bleeding, BMI ≥ 25kg/m2, and MCV ≥ 95fL were associated with MH.