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* = Presenting author

P618 A Mayo endoscopic sub-score of zero predicts long-term remission in patients with ulcerative colitis treated with mesalazine

R. Sakemi*1, 2, H. Tanaka1, M. Miyakawa1, M. Nasuno1, S. Motoya1

1Sapporo Kosei General Hospital, IBD Centre, Sapporo, Japan, 2Tobatakyoritsu Hospital, Department of Gastroenterology, Kitakyusyu, Japan

Background

It is not clear whether a Mayo Endoscopic Sub-score of 0 is associated with improved long-term outcomes compared with a Mayo Endoscopic Sub-score of 1 in patients with ulcerative colitis (UC). Here, we evaluated the validity of a Mayo Endoscopic Sub-score of 0 or 1 in predicting the long-term outcomes of patients with UC who have achieved remission using mesalazine.

Methods

We retrospectively analysed the medical records of patients with UC treated using a 2.4 or 3.6g/day of a pH-dependent release formulation of mesalazine (pH-mesalazine) at our hospital between January 2009 and December 2010. The inclusion criteria were colonoscopy (CS) performed between 1 and 2 years after the start of pH-mesalazine; no other therapy was received after the start of pH-mesalazine; in remission, defined as a Lichtiger clinical activity index (CAI) score of ≤ 4, on the day of CS; and a Mayo Endoscopic Sub-score of 0 or 1 on the day of CS. Flare up of UC was defined as a CAI score of ≥ 5. The cumulative remission rate since the day of CS was estimated using the Kaplan–Meier method. We investigated the cumulative remission rates and characteristics of the patients stratified by Mayo Endoscopic Sub-scores 0 and 1. Prognostic factors related to the cumulative remission rates were evaluated using log-rank tests and multivariate Cox regression analysis.

Results

In total, 74 patients (mean age 45.6 years) were included in this study; 34 were female. The mean duration of disease was 9.2 years. Further, 19 patients had pancolitis; 31 had left-sided colitis; and 24 had proctitis-type colitis. In addition, 56 patients were switched from a time-dependent release formulation of mesalazine or salazosulfapyridine to a pH-mesalazine. Concomitant treatment with azathioprine and local mesalazine was administered to 7 and 20 patients, respectively. On the day of CS, 23 and 51 patients had Mayo Endoscopic Sub-scores of 0 and 1, respectively. Compared with patients with a Mayo Endoscopic Sub-score of 1, those with a Mayo Endoscopic Sub-score of 0 were older and had less pancolitis. The 1-, 2- and 3-year cumulative remission rates were 92%, 83%, and 67%, respectively. The 1- and 3-year cumulative remission rates were 100% and 89%, respectively, for the Mayo Endoscopic Sub-score of 0, 88% and 54%, respectively, for the Mayo Endoscopic Sub-score of 1. The cumulative maintenance rates in the Mayo Endoscopic Sub-score of 0 were significantly higher than those in the Mayo Endoscopic Sub-score of 1. In the multivariate Cox regression analysis, a Mayo Endoscopic Sub-score of 0 was identified as an independent prognostic factor of improved long-term clinical remission.

Conclusion

This study found a Mayo Endoscopic Sub-score of 0 is a prognostic factor of higher remission rates for UC.