Response Rates and Clinical Remission With Different Treatment Patterns and Sequencing in Ulcerative Colitis Patients
BACKGROUND: The treatment of ulcerative colitis (UC) remains challenging, with several strategies available. Therapeutic options include aminosalicylates, corticosteroids, immunosuppressants, and biological therapy. Rates of response vary with the medication used and the standard of treatment. The response rates are estimated to decrease with medication change, but studies are scarce in the literature.
OBJECTIVES: To evaluate the treatment patterns, the sequencing and the response in patients with UC treated in Brazil.
METHODS: Retrospective observational study with the inclusion of 44 IBD outpatients from a referral center in the interior of the state of São Paulo, Brazil. Frequency of medication used was evaluated as the first, second and third choice since the beginning of the UC treatment, in addition to the rates of response and remission according to the treatment. Disease activity was analyzed according to the Mayo score. Clinical response was defined as a score drop of at least 3 points; and clinical remission as Mayo score of 0-2 points. Statistical analysis: association tests, P < 0.05.
RESULTS: The mean age was 50.53 ± 16.55 years, 68.18% were female and Caucasian (95.45%); the mean follow-up time was 10.74 ± 7.00 years. More than half of the patients (54.55%) had pancolitis; 25% distal colitis and 20.45% sided-left hemicolitis. Data from the last patient medical appointment showed that 77.27% were in clinical remission; 13.64% in mild disease activity; 4.55% in moderate disease activity, and 4.55% in severe disease activity. About 43% of the patients presented a previous history of hospitalization and 9% abdominal surgery. Regarding the treatment review, the most commonly used drugs, as the first treatment option, were aminosalicylates (70.45%), azathioprine (20.45%), adalimumab (4.55%) and infliximab (2.27%). The average time of use of this first option was 283.59 ± 495.89 months and the response and remission rates were 58.14% and 69.77%, respectively. The Mayo's score dropped with the treatment (4.65 ± 2.71 vs 2.14 ± 2.80; P = 0.0003). There was no difference in response (P = 0.45) and remission rates (P = 0.22) between the classes of medications used. Most patients keep using the first medication (70.45%). The second option medications were aminosalicylates (50%), azathioprine (19.44%), prednisone (16.67%), infliximab (8.33%), methotrexate (2.78%) and one investigational study drug (2.78%). Time of use was 39.88 ± 37.58 months and response and remission rates were 78.13% and 68.75%, with no difference between medications (P = 0.89 and P = 0.18; respectively) and a drop of Mayo score was observed (4.86 ± 3.09 vs 1.80 ± 2.27; P = 0.0037). The medications used as third option were aminosalicylates (36.36%), prednisone (45.45%), azathioprine (9.09%) and infliximab (9.09%). Time of use was 20.63 ± 20.95 months, 15% maintain the use of these medications and response and remission rates were 54.55% and 45.45%, with no difference between medications (P = 0.33 and P = 0.24 respectively). The Mayo's score dropped (5.86 ± 3.09 vs 3.82 ± 3.46; P = 0.0008). There was no difference between response rates of the first vs the second medication used (P = 0.14) and response rate was lower with the third medication compared to the second medication (P = 0.0098).
CONCLUSION(S): The most commonly medications used were aminosalicylates, followed by azathioprine. Response rates were higher with the first and second prescribed medication.
