title: Rate and Predictors of Mucosal Healing in Ulcerative Colitis Treated with Thiopurines: Results of a Multicentric Cohort Study.
abstract: Mucosal healing (MH) with thiopurines has been poorly investigated in ulcerative colitis (UC). We aimed to assess MH rate in UC patients treated with thiopurine monotherapy.
  
  
  
  We retrospectively collected all UC patients treated with thiopurines more than 6 months who have undergone colonoscopy at baseline and after at least 6 months of treatment. Patients were recruited from January 2005 to May 2015 through a personal database and/or standardized hospital inpatient diagnostic dataset. Patients were excluded in case of any use of other immunomodulator or biological agent. MH was defined as a Mayo endoscopic subscore ≤1 and UCEIS ≤ 2. Histological healing (HH) was defined by the absence of epithelial polynuclear infiltrate, cryptic abscesses, or ulcerations.
  
  
  
  Eighty patients (31 women, median age 43 [IQR 32-58]) were included. Median disease duration was 10.5 [6-16] years. At baseline, median full Mayo score, endoscopic subscore, and UCEIS were 8 [6.8-10], 3 [2-3], and 5 [3-6], respectively. MH was first assessed after a mean follow-up of 38 ± 31 months. Median full Mayo score, endoscopic subscore, and UCEIS decreased to 3.5 [1-6], 2 [0-2.2], and 2 [0-4], respectively. MH was achieved in 43.7%, HH in 38%. In multivariate analysis, predictors of MH were thiopurine exposure duration ≥2 years [odds ratio (OR) 2.9, CI 95% (1.1-7.6), p = 0.03] and a prior acute severe colitis [OR 5.9, CI 95% (1.1-32), p = 0.04]. Factors associated with MH during treatment were partial Mayo score ≤2 (NPV = 100%), BMI ≥ 25 kg/m2(NPV = 75%), and MCV ≥ 95 fL (NPV = 73%).
  
  
  
  In UC, thiopurine monotherapy is associated with MH in 43.7% and HH in 38%.
authors.affiliation: Division of Gastroenterology, Department of Gastroenterology, Cochin Hospital AP-HP, 27, rue du Faubourg Saint Jacques PARIS, 75014, Paris, France. prieuxcaroline@gmail.com.
authors.forename: Caroline
authors.identifier: 0000-0001-8749-651X
authors.initials: C
authors.lastname: Prieux-Klotz
authors.affiliation: Division of Gastroenterology, GHI Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nahon
authors.affiliation: Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA75-73, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Amiot
authors.affiliation: Division of Gastroenterology, Begin Military Hospital, Saint-Mandé, France.
authors.forename: Leila
authors.initials: L
authors.lastname: Sinayoko
authors.affiliation: Division of Gastroenterology, Val de Grace Military Hospital, Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Galéano-Cassaz
authors.affiliation: Division of Gastroenterology, Department of Gastroenterology, Cochin Hospital AP-HP, 27, rue du Faubourg Saint Jacques PARIS, 75014, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
authors.affiliation: Division of Gastroenterology, Department of Gastroenterology, Cochin Hospital AP-HP, 27, rue du Faubourg Saint Jacques PARIS, 75014, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Coriat
authors.affiliation: Emile Roux Hospital AP-HP, Limeil-Brevannes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lahmek
authors.affiliation: Division of Gastroenterology, Department of Gastroenterology, Cochin Hospital AP-HP, 27, rue du Faubourg Saint Jacques PARIS, 75014, Paris, France.
authors.forename: Vered
authors.initials: V
authors.lastname: Abitbol
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine
keywords: Azathioprine; Histological healing; Mayo score; Mercaptopurine; Mucosal healing; Thiopurine; UCEIS; Ulcerative colitis