title: Randomised clinical study: discrepancies between patient-reported outcomes and endoscopic appearance in moderate to severe ulcerative colitis.
abstract: BACKGROUND
  Associations between patient-reported outcomes and mucosal healing have not been established in ulcerative colitis (UC).
  
  
  OBJECTIVE
  To evaluate relationships of rectal bleeding and stool frequency with mucosal healing and quality of life (QoL) in patients with UC in two Phase 3 studies (ULTRA 1 and 2).
  
  
  METHODS
  Associations of patient-reported rectal bleeding and stool frequency subscores with mucosal healing (Mayo endoscopy subscore = 0 or 0/1) and QoL [inflammatory bowel disease questionnaire (IBDQ)] were assessed in adalimumab-randomised patients (160/80 mg at Weeks 0/2 followed by 40 mg biweekly or weekly) at Weeks 8 (n = 433) and 52 (n = 299), and in patients with mucosal healing [endoscopy subscore = 0 (n = 17); 0/1 (n = 52)] at Weeks 8 and 52.
  
  
  RESULTS
  At Week 8, the positive predictive values (PPVs) of rectal bleeding subscore = 0, stool frequency subscore = 0 or both scores = 0 for endoscopy subscore = 0/1 were 69%, 84% and 90% respectively; all proportions increased at Week 52. Equivalent PPVs for these subscores in patients with endoscopy subscore = 0 were 26%, 37% and 46% respectively. Among patients with endoscopy subscore = 0 at Week 8, 87% reported no rectal bleeding, while only 29% reported normal stool frequency; these proportions had increased to 94% and 41% respectively, at Week 52. Among patients with mucosal healing, IBDQ scores trended highest for patients with both rectal bleeding and stool frequency subscores = 0.
  
  
  CONCLUSIONS
  Absence of rectal bleeding and normal stool frequency are often predictive of mucosal healing and QoL, but complete normalisation of stool frequency is encountered rarely in patients with mucosal healing.
authors.affiliation: The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: B
authors.initials: B
authors.lastname: Jharap
authors.affiliation: Inflammatory Bowel Disease Center, Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Sandborn
authors.affiliation: Department of Gastroenterology, McMaster University, Hamilton, ON, Canada.|Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Reinisch
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: D'Haens
authors.affiliation: AbbVie Inc., North Chicago, IL, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Robinson
authors.affiliation: AbbVie Inc., North Chicago, IL, USA.
authors.forename: W
authors.initials: W
authors.lastname: Wang
authors.affiliation: AbbVie Inc., North Chicago, IL, USA.
authors.forename: B
authors.initials: B
authors.lastname: Huang
authors.affiliation: AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Lazar
authors.affiliation: AbbVie Inc., North Chicago, IL, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Thakkar
authors.affiliation: The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: J-F
authors.initials: JF
authors.lastname: Colombel
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003672:Defecation / Q000502:physiology; D004724:Endoscopy; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects*; D063868:Patient Outcome Assessment; D011788:Quality of Life; D012007:Rectum; D012074:Remission Induction; D057566:Self Report; D011795:Surveys and Questionnaires; D014945:Wound Healing
chemical_list: D000893:Anti-Inflammatory Agents; D000068879:Adalimumab