Early Sonographic Improvement Predicts Clinical Remission and Mucosal Healing With Molecular-Targeted Drugs in Ulcerative Colitis

• Published in: Gastro hep advances Vol. 3; no. 6; pp. 703 - 710
• Main Authors: Kimura, Yoko, Miyoshi, Jun, Morikubo, Hiromu, Komatsu, Haruka, Moue, Chihiro, Yonezawa, Hiromi, Matsuura, Minoru, Hisamatsu, Tadakazu
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 2024; Elsevier
• Subjects: Clinical Remission; Endoscopic Improvement; Intestinal Ultrasound; Molecular-Targeted Drug; Original Research—Clinical; Ulcerative Colitis; Molecular-Targeted Drug; KUC-UC; SE-EI; UC; BWF; Ulcerative Colitis; PPV; MUC; BWT; BWS; EI; SFCR; Endoscopic Improvement; IUS; IQR; SMI; CS; UII; Intestinal Ultrasound; mLS; MES; SMT; Clinical Remission; MTD; LI
• ISSN: 2772-5723; 2772-5723
• DOI: 10.1016/j.gastha.2024.04.007

Predicting the efficacy of molecular-targeted drugs (MTDs) is an unmet need in the treatment of ulcerative colitis (UC). Intestinal ultrasound (IUS) can be used to safely and repeatedly assess UC activity. Thirty-eight patients who started MTD therapy for active UC and underwent IUS at baseline and 3 months after starting therapy were analyzed. Steroid-free clinical remission (SFCR) and endoscopic improvement (EI) at 6 months were defined as a Lichtiger index of ≤3 and Mayo endoscopic subscore of ≤1 while continuing the MTD without steroid induction or surgery. Sonographically estimated EI (SE-EI) at 3 months was assessed based on a Milan Ultrasound Criterion of ≤6.2 and Kyorin Ultrasound Criterion for UC (bowel wall thickness of <3.8 mm and submucosa index of <50%). Thirty-one patients achieved SFCR at 6 months [SFCR(+) group]. The SFCR(+) group demonstrated significantly better improvement in bowel wall thickness and bowel wall vascularity at 3 months than the SFCR(−) group. The Milan Ultrasound Criterion and UC-IUS index also improved significantly more in the SFCR(+) than SFCR(−) group. The areas under the curve of these parameters for predicting SFCR were approximately 0.80. Colonoscopy was performed for 28 patients at 6 months, and 15 patients achieved EI. SE-EI at 3 months was significantly associated with achievement of EI at 6 months. The positive predictive values of SE-EI at 3 months for SFCR and EI at 6 months were 100%. Sonographic improvements in 3 months predicted the clinical and endoscopic efficacy of MTD therapy at 6 months, suggesting the longitudinal significance of IUS monitoring for UC treatment.