Inflammation on Index Biopsy Predicts Loss of Remission Among Ulcerative Colitis Patients with Endoscopic Remission: a US Cohort Analysis.

Challenge

Histologic inflammation persists in a significant proportion of UC patients who achieve endoscopic remission, but the real-world impact of residual histologic activity on subsequent loss of remission had not been quantified in a large prospective US cohort, leaving uncertainty about whether histologic healing should be a treatment target.

Solution

The TARGET-IBD registry was used to assess the association between histologic inflammation on index biopsy and loss of remission in corticosteroid-free UC patients in endoscopic remission, with multivariable Cox regression identifying histologic inflammation as an independent predictor of LOR.

Impact

Establishing that histologic inflammation in endoscopic remission is associated with a two-fold increased risk of UC LOR provides real-world evidence supporting histologic remission as an additional treatment target beyond endoscopic remission, informing treat-to-target strategies for next-generation UC therapies.