The Timing of Endoscopic Evaluation of Anti-TNFα Therapy Patients with Ulcerative Colitis

Abstract

Anti-TNFα Therapy are used to induce remission and as maintenance therapy in refractory ulcerative colitis (UC) to achieve mucosal healing (MH). However, the time at which mucosal healing should be assessed is unclear. We retrospectively examined the optimal timing for colonoscopy and the criteria to determine the need for the continuation of treatment. We evaluated 44 UC patients that were treated with anti-TNFα Therapy and categorized them into the following groups according to the degree of MH within 12 months: MH and non-MH/NMH, early-MH (EMH, healing within three months), and slow MH/SMH (healing between 4-12 months). We compared the Mayo Endoscopic Subscore (MES) between the MH vs. NMH and SMH vs. NMH groups. The Lichtiger index and blood test results were investigated as predictive factors of MH. MH was defined as an MES of ≤ 1. The MES was significantly lower in the MH group at 3, 6, and 12 months, compared to the NMH group. Significant changes were observed in the platelet counts, the Lichtiger index, the levels of C-reactive protein (lower), and hemoglobin (higher) in the MH group at 3- and 6-months following treatment. However, the only significant difference between the SMH and NMH groups was in the endoscopic findings at 6- or 12-months post-treatment. Colonoscopy should be performed three months after treatment with anti-TNFα Therapy. The treatment should be continued in patients who do not achieve mucosal healing at 3-months, and colonoscopy should be repeated at 6- or 12-months to assess the outcomes.