1. Long‐term follow‐up of patients treated with aminosalicylates for ulcerative colitis: Predictive factors of response: An observational case‐control study
- Author
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Marta Maia Bosca-Watts, Pablo Navarro, Joan Tosca, Isabel Pascual, Francisco Mora, Miguel Minguez, María Pilar Ballester, David Martí-Aguado, and Rosario Anton
- Subjects
Adult ,Male ,medicine.medical_specialty ,Aminosalicylic acid ,Long term follow up ,Treatment outcome ,Biological Factors ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Clinical Decision Rules ,Internal medicine ,medicine ,Humans ,Immunologic Factors ,Colitis ,Retrospective Studies ,business.industry ,Incidence ,Gastroenterology ,Case-control study ,Original Articles ,Middle Aged ,medicine.disease ,Ulcerative colitis ,Aminosalicylic Acids ,Treatment Outcome ,Oncology ,chemistry ,Case-Control Studies ,030220 oncology & carcinogenesis ,Colitis, Ulcerative ,Female ,030211 gastroenterology & hepatology ,Observational study ,business ,Follow-Up Studies - Abstract
BACKGROUND: Knowing patients' ulcerative colitis history is essential to selecting the appropriate therapy according to risk stratification. OBJECTIVE: To evaluate and identify predictive factors of non-response to aminosalicylates judged as the need for a step-up approach over time. METHODS: A case-control study of ulcerative colitis patients treated with aminosalicylates after the diagnosis of disease flare included in the ENEIDA single-centre registry from 1997 to 2017. Long-term treatment maintenance with aminosalicylates and higher therapeutic requirements were recorded. The cumulative incidence of treatment escalation was estimated using Kaplan-Meier curves and compared by the log-rank test. Cox regression analysis was performed to identify predictive factors of treatment with immunomodulators, biological agents or surgery. RESULTS: A total of 457 patients were included, of whom 28% (n = 126) were non-responders to aminosalicylates. The cumulative probability for a step-up approach within 20 years of follow up was 35%, mainly due to steroid-dependent colitis. Risk factors for treatment escalation were age ≤27 years (hazard ratio 2.31, 95% confidence interval 1.36–3.92), extensive colitis (hazard ratio 1.65, 95% confidence interval 1.04–2.60), Mayo endoscopic subscore ≥2 (hazard ratio 1.45, 95% confidence interval 1.02–2.06) and extraintestinal manifestations (hazard ratio 2.04, 95% confidence interval 1.03–4.05). CONCLUSIONS: Aminosalicylates represent an effective maintenance therapy. Younger age, extensive colitis, endoscopic disease severity and extraintestinal manifestations are risk factors for higher therapeutic requirements.
- Published
- 2019