Ulcerative colitis treatment : an insight into daily clinical practice
Journal | Volume 82 - 2019 |
Issue | Fasc.3 - Original articles |
Author(s) | P. Bossuyt, F. Baert, J.L. Coenegrachts, M. De Vos, O. Dewit, M. Ferrante, F. Fontaine, F. Mana, J. Vandervoort, T. Moreels |
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(1) Department of Gastroenterology, Imelda GI Clinical Research, Imelda General Hospital, Bonheiden, Belgium ; (2) Department of Gastroenterology, AZ Delta, Roeselare, Belgium ; (3) Department of Gastroenterology, Jessa Ziekenhuis, Hasselt, Belgium ; (4) Department of Gastroenterology, University Hospitals Gent, Gent, Belgium ; (5) Department of Gastroenterology, UCL Saint Luc, Brussel, Belgium ; (6) Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium ; (7) Department of Gastroenterology, Clinique Saint Joseph, Liège, Belgium ; (8) Department of Gastroenterology, UZ Brussel, Brussel, Belgium ; (9) Department of Gastroenterology, OLV Ziekenhuis, Aalst, Belgium. |
Background : The natural history of ulcerative colitis (UC) is unpredictable. Factors associated with the need for different types of step-up therapy in UC patients failing on 5-aminosalicylic acid (5-ASA) or corticosteroids are understudied. Aims : Describe step-up therapy in patients with UC the first year after failing on 5-ASA or corticosteroids. Methods : A Belgian, multi-center, prospective, non-interven- tional observational study comprising adult UC patients failing on 5-ASA or corticosteroids and naïve to immunomodulators/ biologicals. During a 12 months follow-up, patient characteristics, demography, medical therapy, biomarkers, therapy adherence and quality of life (QoL) were assessed. Results : After 1 year, 35% of the patients were on biological therapy. Use of anti-TNF differed depending on baseline treatment: corticosteroid-refractory patients (55.8%), 5-ASA refractory (20.0%), and corticosteroid-dependent (16.0%) patients (p<0.001). The decision to start a line of therapy was based on the Mayo combined severity but not on biomarkers like faecal calprotectin, haemoglobin, CRP, albumin, platelets, and number of extra- intestinal manifestations. At year 1, 84.2% of the patients had only mild UC or remission and a significant improvement of fatigue (p=0.004) and IBDQ scores (p<0.001) were observed implying an improved QoL. Conclusion : Treatment step-up, based on clinical scores in immunomodulatory and anti-TNF naïve patients with UC, provides good clinical outcomes and QoL. (Acta gastroenterol. belg., 2019, 82, 365-372). |
© Acta Gastro-Enterologica Belgica. PMID 31566323 |