Early Intestinal Ultrasound Predicts Long-Term Endoscopic Response to Biologics in Patients With Ulcerative Colitis
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND AND AIM
Milan ultrasound criteria (MUC) is a validated score to assess endoscopic activity in ulcerative colitis (UC). MUC > 6.2 detects Mayo endoscopic score (MES) > 1. In this study we evaluated the predictive value of MUC for biologic treatment response, using colonoscopy (CS) as reference standard.
METHODS
Consecutive UC patients starting biologic therapy were included, and underwent CS, IUS, clinical assessment and faecal calprotectin (FC) measurement at baseline and within one year. In addition, IUS, clinical and FC assessments were performed at week 12. The primary objective was to evaluate whether ultrasound improvement (MUC < 6.2) at week 12 predicted endoscopic improvement at reassessment (MES < 1). Endoscopic remission was defined as MES = 0.
RESULTS
Forty-nine patients were included (59% under infliximab, 29% under vedolizumab, 8% under adalimumab, 4% under ustekinumab). MUC < 6.2 at week 12 was the only independent predictor for MES < 1 and MES = 0 at reassessment (OR 5.80, p = 0.010; OR 10.41, p = 0.041; respectively). MUC < 6.2 at week 12 showed NPV of 96% for detecting MES = 0. A ≥ 2 reduction of the MUC predicted MES=0 (AUC 0.816). MUC < 4.3 was the most accurate cut-off value for MES = 0 (AUC 0.876). The responsiveness ratio of Guyatt for the MUC was 1.73 (> 0.8).
CONCLUSION
MUC < 6.2 at week 12 predicts long-term endoscopic response. MUC is accurate to monitor treatment response and may be used both in clinical trials and routine practice.
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Additional Info
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Early intestinal ultrasound predicts long-term endoscopic response to biologics in ulcerative colitis
J Crohns Colitis 2023 Apr 21;[EPub Ahead of Print], M Allocca, C Dell'Avalle, F Furfaro, A Zilli, F D'Amico, L Peyrin-Biroulet, G Fiorino, S DaneseFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Intestinal ultrasound (IUS) is an established, non-invasive tool for IBD evaluation. In ulcerative colitis (UC), IUS is a reliable technique with strong inter-observer agreement for disease activity and severity.1
In this study by Allocca et al, the use of IUS in 49 patients with UC at week 12 following biologic therapy predicted 1-year endoscopic response. Mayo endoscopic score (MES) was compared with the validated Milan ultrasound criteria (MUC).2,3 A week-12 MUC ≤6.2 correlated with endoscopic improvement (MES ≤1) with a specificity, accuracy, positive predictive value, and negative predictive value of 67%, 78%, 73%, and 67%, respectively. A MUC ≤4.3 was the best predictor of endoscopic remission (MES = 0).
Comparably, in the TRUST&UC study, bowel wall thickness (BWT) normalization alone had a high correlation with clinical response at 12 weeks;4 whereas de Voogd et al5 showed that a BWT of 2.8 mm and 3.9 mm correlated with endoscopic remission and improvement, respectively, after 8 weeks of tofacitinib. Allocca et al’s work is provocative and queries whether IUS scores like MUC should be routinely used for early UC assessment. Further validation studies are needed to assess whether BWT alone or MUC is the best option. Overall, IUS is advantageous and can become a mainstay for frequent monitoring in a “treat-to-target” strategy.
References