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. 2024 Apr 23;3(6):703-710.
doi: 10.1016/j.gastha.2024.04.007. eCollection 2024.

Early Sonographic Improvement Predicts Clinical Remission and Mucosal Healing With Molecular-Targeted Drugs in Ulcerative Colitis

Yoko Kimura  1 , Jun Miyoshi  1 , Hiromu Morikubo  1 , Haruka Komatsu  1 , Chihiro Moue  1 , Hiromi Yonezawa  1 , Minoru Matsuura  1 , Tadakazu Hisamatsu  1
Affiliations

Early Sonographic Improvement Predicts Clinical Remission and Mucosal Healing With Molecular-Targeted Drugs in Ulcerative Colitis

Yoko Kimura et al. Gastro Hep Adv. .

Abstract

Background and aims: Predicting the efficacy of molecular-targeted drugs (MTDs) is an unmet need in the treatment of ulcerative colitis (UC). Intestinal ultrasound (IUS) can be used to safely and repeatedly assess UC activity.

Methods: Thirty-eight patients who started MTD therapy for active UC and underwent IUS at baseline and 3 months after starting therapy were analyzed. Steroid-free clinical remission (SFCR) and endoscopic improvement (EI) at 6 months were defined as a Lichtiger index of ≤3 and Mayo endoscopic subscore of ≤1 while continuing the MTD without steroid induction or surgery. Sonographically estimated EI (SE-EI) at 3 months was assessed based on a Milan Ultrasound Criterion of ≤6.2 and Kyorin Ultrasound Criterion for UC (bowel wall thickness of <3.8 mm and submucosa index of <50%).

Results: Thirty-one patients achieved SFCR at 6 months [SFCR(+) group]. The SFCR(+) group demonstrated significantly better improvement in bowel wall thickness and bowel wall vascularity at 3 months than the SFCR(-) group. The Milan Ultrasound Criterion and UC-IUS index also improved significantly more in the SFCR(+) than SFCR(-) group. The areas under the curve of these parameters for predicting SFCR were approximately 0.80. Colonoscopy was performed for 28 patients at 6 months, and 15 patients achieved EI. SE-EI at 3 months was significantly associated with achievement of EI at 6 months. The positive predictive values of SE-EI at 3 months for SFCR and EI at 6 months were 100%.

Conclusion: Sonographic improvements in 3 months predicted the clinical and endoscopic efficacy of MTD therapy at 6 months, suggesting the longitudinal significance of IUS monitoring for UC treatment.

Keywords: Clinical Remission; Endoscopic Improvement; Intestinal Ultrasound; Molecular-Targeted Drug; Ulcerative Colitis.

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Figures

Figure 1
Figure 1
Changes in intestinal sonographic findings at 3 months and achievement of SFCR at 6 months after starting a molecular-targeted drug. The changes (Δ) in intestinal sonographic findings at 3 months with a molecular-targeted drug were compared between patients who did and did not achieve SFCR at 6 months. In calculating Δ%, the value at baseline was defined as 100%. (A) ΔBowel wall thickness (mm) and Δ%bowel wall thickness. (B) ΔModified Limberg score (mLS) and Δ%mLS. (C) Proportions of patients with each change pattern of bowel wall stratification. (D) ΔMilan Ultrasound Criterion and Δ%Milan Ultrasound Criterion. (E) ΔUC-IUS index and Δ%UC-IUS index. ∗P < .05 and ∗∗P < .01 with Mann–Whitney U test. IUS, intestinal ultrasound; SFCR, steroid-free clinical remission; UC, ulcerative colitis.
Figure 2
Figure 2
Changes in intestinal sonographic findings in 3 months and achievement of EI at 6 months after starting a molecular-targeted drug. The changes (Δ) in intestinal sonographic findings at 3 months with a molecular-targeted drug were compared between patients who did and did not achieve EI (Mayo endoscopic subscore of ≤1) at 6 months. (A) ΔBowel wall thickness (mm) and Δ%bowel wall thickness. The bowel wall thickness at baseline was defined as 100% in calculating Δ%bowel wall thickness. (B) ΔModified Limberg score and Δ%modified Limberg score. The modified Limberg score at baseline was defined as 100% in calculating Δ%modified Limberg score. (C) Proportions of patients with each change pattern of bowel wall stratification (unclear/loss to unclear/loss, unclear/loss to maintained, and maintained to maintained). (D) ΔMilan Ultrasound Criterion and Δ%Milan Ultrasound Criterion. (E) ΔUC-IUS index and Δ%UC-IUS index. ∗P < .05 with Mann-Whitney U test. EI, endoscopic improvement; IUS, intestinal ultrasound; UC, ulcerative colitis.
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