P412 Evolution of patients with ulcerative colitis who withdraw the maintenance treatment with mesalazine
A. Algaba*, I. Guerra, D. Bonillo, M. Hernández, A. Granja, P. Bernal, F. Berrmejo
Hospital Universitario de Fuenlabrada, Gastroenterology, Madrid, Spain
Mesalazine (MSZ) is frequently used as maintenance therapy for ulcerative colitis (UC). Although its maintenance is recommended, it is not surprising that some patients discontinue treatment, especially patients free of symptoms for a long time. Our aims were to evaluate the evolution of patients who withdrew treatment with MSZ and to establish the possible factors associated with disease relapse
Retrospective observational study in patients with UC on remission who withdrew maintenance treatment with oral MSZ to continue without treatment. Demographics and clinical data regarding UC and its treatment were collected
We reviewed 301 patients with UC, of these 35 patients (mean age 50 ± 14 y; 54% males, 14% smokers) withdrew maintenance treatment with oral MSZ. Further, 20.6% had proctitis; 44.1% left-sided colitis; 26.5% pancolitis; and 8.8% atypical disease location. In addition, 55.9% of patients had previously experienced at least a mild flare of UC during the evolution of disease; 29.4% had had moderate and 14.7% severe flares. Moreover, 45.7% had received corticosteroids sometime (69.2% 1–2 cycles, 23.1% 3–4 cycles, and 7.7% more than 5 cycles), and 28.6% had required hospitalisation because of UC. The mean time of UC evolution until MSZ withdrawal was 7.1 ± 6.0y. MSZ treatment was maintained during a median of time of 48 months (IQR 12–132) until withdrawal (mean MSZ dose 1.9 ± 0.9g per day), and 34.3% of patients were on topical MSZ that was also withdrawn. Reasons for withdrawing MSZ were long-term remission (n = 15; 42.9%, mean time of remission 84.0 ± 47.5 months), patient’s choice (n = 18; 51.4%), and side effects (n = 2; 5.7%). Globally, 57.1% of patients had at least one flare after a period of time without treatment (median time to first flare was 27 months (IQR 8–78); 71.4% of patients without relapse at the first year of follow-up); and 40% required oral corticosteroids. Finally, 75% of patients who suffered a flare needed maintenance therapy again with oral MSZ (25% of them in combination with topical MSZ) and 15% required immunosuppressant drugs, whereas 25% had more severe flares. Nevertheless, the numbers of corticosteroids cycles or numbers of visits to outpatient clinic (1.6 ± 1.0 vs 1.3 ± 1.3) were not higher after ceasing MSZ (p > 0.05). Occurrence of flare was not different according to sex (p = 0.95), disease location (p = 0.94), reason for withdrawing (p = 0.25), time of remission (p = 0.47), severity of previous relapses (p = 0.08), or time of evolution of UC (p = 0.08).
More than half of patients discontinuing maintenance treatment with MSZ suffer new flares of the disease some time later. In three-quarters of these cases, it is necessary to resume therapy with MSZ. Factors associated with disease relapse after stopping treatment were not found