title: Tacrolimus for remission induction in ulcerative colitis: Mayo endoscopic subscore 0 and 1 predict long-term prognosis.
abstract: BACKGROUND
  Tacrolimus has shown efficacy in patients with ulcerative colitis.
  
  
  OBJECTIVE
  To evaluate the efficacy of tacrolimus as remission induction therapy and assess medium to long-term outcomes in patients who achieve remission.
  
  
  METHODS
  Forty-four ulcerative colitis patients who were treated with tacrolimus in three institutes during 2009-2013 were retrospectively reviewed. Short-term efficacy was based on the clinical activity index and the Mayo endoscopic subscores. Clinical activity index≤4 meant clinical remission, while Mayo endoscopic subscore 0 or 1 meant mucosal healing. Medium to long-term prognosis was based on relapse free survival in relation to the Mayo endoscopic subscore and duration of tacrolimus therapy in patients who achieved remission.
  
  
  RESULTS
  At 12 weeks, clinical remission was achieved in 29 of 44 patients (65.9%). Thirty-two patients received endoscopic evaluations, and mucosal healing rate was 43.8%. Among patients with clinical remission, mucosal healing rate was 60.9%. Relapse-free survival at 6, 12, and 24 months were 66%, 56%, and 50%, respectively, and was higher in patients on long-term tacrolimus (over 4 months, P=0.03), and patients with better endoscopic subscore (P=0.009).
  
  
  CONCLUSIONS
  Mucosal healing observed within 12 weeks or after a longer duration of tacrolimus therapy was associated with significantly better remission maintenance time.
authors: Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan.
authors: Kentaro
authors: K
authors: Ikeya
authors: First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors: Ken
authors: K
authors: Sugimoto
authors: Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan.
authors: Shinsuke
authors: S
authors: Kawasaki
authors: Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan.
authors: Takayuki
authors: T
authors: Iida
authors: Department of Gastroenterology, Fujieda Municipal General Hospital, Fujieda, Japan.
authors: Yasuhiko
authors: Y
authors: Maruyama
authors: Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan.
authors: Fumitoshi
authors: F
authors: Watanabe
authors: Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan. Electronic address: hanai@hamamatsu-minami.com.
authors: Hiroyuki
authors: H
authors: Hanai
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Mayo endoscopic subscore; Mucosal healing; Response to tacrolimus; Ulcerative colitis