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• W2975695394 abstract "There is strong evidence supporting the use of aminosalicylates for induction and for maintenance of remission in patients with mild-to-moderate ulcerative colitis (UC).1-5 Recognizing patients at risk of medical therapy failure can appropriately optimize treatment escalation based on risk stratification.6 Predictive factors of nonresponse to steroids–or even biologics–in the long term have been extensively studied. However, little is known about the long-term course of the disease judged by the need for treatment escalation among patients in remission with aminosalicylates. In this context, the study by Marti-Aguado et al. evaluated predictive factors of nonresponse to aminosalicylates, defined as the need for a step-up approach over time.7 This was a retrospective case-control study of UC patients treated with aminosalicylates after diagnosis disease flare, from 1997 to 2017. Long-term treatment maintenance with aminosalicylates and higher therapeutic requirements were recorded, and a detailed analysis was performed to identify predictive factors of treatment with immunomodulators, biological agents or surgery. The most relevant results of this study can be summarized as follows: A total of 457 patients were included, of whom only 28% were nonresponders to aminosalicylates, judged as the need for higher therapeutic requirements. Cumulative probability for a step-up approach within 20 years of follow-up was 35%, mainly due to steroid-dependent colitis (76%); other causes of treatment escalation included steroid-refractory colitis (13%) and extraintestinal manifestations (5%). Higher therapeutic requirements included mainly immunomodulators (97%), but also, of note, biological agents (57%) and even colectomy (13%). The cumulative probability for treatment escalation was 7%, 23%, and 30% at 1, 5, and 10 years, respectively. However, the most relevant finding of this study was the identification of clear risk factors for treatment escalation: age 27 years or younger, extensive colitis, Mayo endoscopic subscore 2 or greater, and extraintestinal manifestations. In summary, despite the aforementioned limitations, the interesting study by Marti-Aguado et al.,7 providing real-life information, confirmed that nonresponse to aminosalicylates–judged as the need for higher therapeutic requirements–is low and can be predicted by easily assessing factors that may affect treatment strategies: younger age, extensive colitis, endoscopic disease severity and extraintestinal manifestations. These findings may be used in our clinical practice to identify patients who will probably benefit from an early step-up approach and minimize the morbidity associated with uncontrolled UC. Dr Gisbert has served as a speaker, a consultant and advisory member for or has received research funding from MSD, Abbvie, Hospira, Pfizer, Kern Pharma, Biogen, Takeda, Janssen, Roche, Sandoz, Celgene, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, and Vifor Pharma. Dr Chaparro has served as a speaker or has received research or education funding from MSD, Abbvie, Hospira, Pfizer, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Dr. Falk Pharma, and Tillotts Pharma." @default.
• W2975695394 created "2019-10-03" @default.
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• W2975695394 date "2019-10-01" @default.
• W2975695394 modified "2023-10-15" @default.
• W2975695394 title "Are there reliable predictive factors of nonresponse to aminosalicylates in patients with ulcerative colitis?" @default.
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• W2975695394 doi "https://doi.org/10.1177/2050640619861891" @default.
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