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Targeting Deep Remission: New Strategies in the Management of UC

Targeting Deep Remission: New Strategies in the Management of UC

21 Aug 2021 13:00 13:25
- Supported by Ferring (25 mins)
Byong Duk Ye Speaker
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With advances in medicine, therapeutic targets of ulcreative colitis (UC) have been also evolving. In previous years, symptom-based treatment targeting steroid-free symptomatic remission has been set as a therapeutic target for patients with UC. However, that approach did neither bring a favorable long-term disease course nor reduced a risk of colectomy. Moreover, UC is now believed to be a progressive disease in a substantial proportion of patients. Therefore, it is needed to stratify UC patients depending on prognostic factors at the time of diagnosis for an individualized approach. For those with poor prognostic factors, a more intensive management strategy setting a deeper level of therapeutic target with a tighter monitoring would be required. In the STRIDE (Selecting Therapeutic Targets in Inflammatory Bowel Disease)-II consensus, achieving both clinical remission (an intermediate target) and endoscopic healing (a long-term target) is recommended. It is well known that achieving endoscopic healing (Mayo endoscopic subscore [MES] 0 to 1) is associated with better outcomes compared with remaining on endoscopic activity (MES 2 to 3) in patients with UC. Recently, data is accumulating that MES 0 is superior to MES 1 in terms of future clinical course and MES 0 for patients with UC is recommended as a target in the STRIDE-II consensus. However, a need for targeting MES 0 for all UC patients, its achievability, its implication in disease modification and the benefit-cost ratio are yet to be elucidated. A significant dissociation between endoscopic features and histologic activity has been reported and histologic remission/healing is an emerging target for UC. However, more studies are required for histologic remission/healing to be accepted as a formal target.

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