S1466 A Post-Hoc Analysis of the VARSITY Trial Assessing Outcomes in Mild-to-Moderate Ulcerative Colitis With Histologic Activity and MES 1

Le résumé fourni par la source

Introduction: Mild-to-moderate ulcerative colitis (UC) is traditionally defined by a total Mayo Clinic score ≥4, a Mayo Endoscopic Score (MES) of 2, and a Rectal Bleeding Score (RBS) ≥1. Endoscopic improvement has conventionally included both MES 0 and 1, yet studies indicate differing relapse risks, with MES 1 associated with poorer long-term outcomes. Importantly, patients with MES 1 and ongoing histologic inflammation are often excluded from clinical trials, limiting understanding of their disease trajectory and therapeutic needs. Methods: This post-hoc analysis utilized data from the VARSITY trial. Patients who met the conventional definition of mild-to-moderate UC at week 14 were compared to those with MES 1 and active histology. The primary endpoint was histo-endoscopic mucosal improvement (HEMI) at week 52, defined as MES ≤1 and Geboes score <3.2. Secondary outcomes included endoscopic remission (MES 0), histologic improvement (Geboes <3.2), and clinical remission (total Mayo ≤2 with no subscore >1). Histologic activity was defined as Geboes >3.2. Results: At week 52, both groups showed comparable rates of HEMI [24.1% (19/79) vs 24.8% (28/113); P = 0.908], endoscopic remission [29.1% vs 31.0%; P = 0.782], histologic improvement [29.1% vs 31.9%; P = 0.685], and clinical remission [48.1% vs 58.4%; P = 0.158]. Conclusion: Patients with MES 1 and histologic activity appear to experience similar outcomes to those with mild-to-moderate disease by conventional criteria. These findings challenge current assumptions around disease severity and emphasize the importance of tailoring treatment decisions based on a more nuanced understanding of mucosal and histologic activity. Incorporating histologic assessment into routine practice may improve individualized care and optimize long-term outcomes. Further prospective studies are needed to validate these findings and to better define optimal management strategies for this patient subgroup.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.