Table 1.
Studies reporting long-term benefits of endoscopically defined mucosal healing.
| Study, Year, Design | Population | Definition of MH, Proportion of pts | Outcomes Assessed | Key Findings |
|---|---|---|---|---|
| Long-term disease control | ||||
| Shah et al., 2016, meta-analysis of 13 prospective studies [16] | 2073 pts with active UC | Multiple definitions among included studies | Long-term CR, long-term defined as ≥52 weeks post treatment and ≥6 months post assessment of MH | pOR of 4.50 (95% CI, 2.12–9.52; p < 0.0001) for achieving long-term CR in patients achieving MH compared to those not |
| Shah et al., 2016, meta-analysis of 12 prospective studies [17] | 673 pts with active CD | Multiple definitions among included studies | Long-term CR, long-term defined as ≥50 weeks from study outset | pOR of 2.80 (95% CI, 1.91–4.10; p < 0.00001) for achieving long-term CR in patients achieving MH vs. those not |
| Colombel et al., 2011, retrospective analysis of previous RCT’s [18] | 728 UC pts with MES ≥ 2, treated with IFX or placebo | MES | CR at week 30, CR at week 54 | Lower MES at week 8 was associated with increased likelihood of CR at week 30, 71% MES 0, 51% MES 1, 23% MES 2, 9.7% MES 3, p < 0.0001 and week 54, 73% MES 0, 47% MES 1, 24% MES 2, 10% MES 3, p < 0.0001 among IFX-treated patients |
| Ferrante et al., 2013 [19] | 172 pts with CD treated with IFX, AZA, or both | MH: absence of ulcers Present in: 48% of patients at week 26 of treatment |
CS-free CR at week 50 | MH at week 26 was associated with CS-free CR at week 50 with 56% sensitivity, 65% specificity, PLR of 1.60, and NLR of 0.67. |
| Avoidance of surgery | ||||
| Shah et al., 2016, meta-analysis of 13 prospective studies [16] | 2073 pts with active UC | Multiple definitions among included studies | Avoidance of colectomy at ≥52 weeks post treatment commencement and ≥6 months post finding of MH | pOR of 4.15 (95% CI, 2.53–6.81; p < 0.00001) for avoiding colectomy |
| Colombel et al., 2011, retrospective analysis of previous RCT’s [18] | 728 UC pts with MES ≥ 2, treated with IFX or placebo | MES | Avoidance of colectomy at 54 weeks | Lower MES at week 8 among IFX-treated patients associated with increased likelihood of avoiding colectomy, 95% MES 0, 95% MES 1, 83% MES 2, 80% MES 3, p = 0.0004 |
| Schnitzler et al., 2009, retrospective observational cohort study [20] | 214 CD pts on long-term IFX treatment with endoscopy before and during IFX therapy | Complete MH: absence of ulceration in patients who had ulcerations at baseline—present in 83 pts (45.4%) Partial MH: clear endoscopic improvement but with ulceration present—present in 41 pts (22.4%) |
Avoidance of MAS, defined as any gut resection, stricturoplasty, or faecal diversion surgery during follow-up period—median (IQR) follow-up 68.7 (39.8–94.8) months. | Reduced need for MAS in patients demonstrating complete or partial MH compared to those not, 14.1% vs. 38.4% of patients, p < 0.0001 |
| Frøslie at al., 2007, retrospective observational cohort study [21] | 495 pts with newly diagnosed UC (354) or CD (141) with endoscopic assessment at baseline, 1 and 5 years | Definition of MH not stated. Present in 178 (50%) of UC patients and 53 (38%) of CD patients at one year. | Avoidance of colectomy at 5 years | Presence of MH at 1 year follow-up associated with significantly reduced risk of colectomy at 5 years, RR 0.22 (95% CI, 0.06–0.79; p = 0.02) |
| Long-term mucosal healing | ||||
| Shah et al., 2016, meta-analysis of 13 prospective studies [16] | 2073 pts with active UC | Multiple definitions among included studies | MH at ≥52 weeks post treatment commencement and ≥6 months post finding of MH | pOR of 8.40 (95% CI, 3.13–22.53; p < 0.00001) for achieving long-term MH in patients achieving MH vs. those not |
| Shah et al., 2016, meta-analysis of 12 prospective studies [17] | 673 pts with active CD | Multiple definitions among included studies | Long-term CR. Long-term defined as ≥50 weeks from study outset |
pOR of 14.30 (95% CI, 5.57–36.74; p < 0.00001) for long-term MH in patients achieving MH vs. those not |
| Colombel et al., 2011, retrospective analysis of previous RCT’s [18] | 728 UC pts with MES ≥ 2, treated with IFX or placebo | MES | Sustained mucosal healing at both weeks 30 and 54 | Lower MES at week 8 associated with increased rate of sustained MH at both weeks 30 and 54, 77% MES 0, 54% MES 1, 21% MES 2, 6.7% MES 3, p < 0.0001 among IFX-treated patients |
| Af Björkesten et al., 2013, prospective observational study [22] | 42 pts with active CD treated with IFX or adalimumab | MH: SES-CD 0–2. MH present in 10 (24%) patients at 3 months post therapy commencement. |
Presence of MH at 1 year | Patients with MH at 3 months more likely to demonstrate MH at 1 year than those without, 70% vs. 17%, p = 0.01 |
AZA, Azathioprine; CD, Crohn’s disease; CI, confidence interval; CR, clinical remission; CS, corticosteroid; IFX, Infliximab; MAS, major abdominal surgery; MES, Mayo endoscopy subscore; MH, mucosal healing; NLR, negative likelihood ratio; pOR, pooled odds ratio; PLR, positive likelihood ratio; RCT, randomised, controlled trial; RR, risk ratio; UC, ulcerative colitis.