Predictors of early immunosuppression at ulcerative colitis onset in the biological era.

Background: Unlike Crohn's disease, ulcerative colitis (UC) lacks predictive factors of a bad prognosis. Therefore, immunosuppressant therapy is only considered in a step-up strategy when steroid refractoriness or dependency develops.

Objective: To identify predictive factors for the early use of immunosuppressants, biological agents and colectomy in UC.

Patients and methods: Retrospective, observational study of an incident cohort of UC at two referral centres over a 7-year period. Demographic, clinical, endoscopic and biologic variables at UC diagnosis were collected and early use (within five years) of immunosuppressants, biological agents and colectomy was assessed for a maximum of five years.

Results: A total of 239 patients were included. At baseline, 32% presented with extensive colitis, 15% severe disease activity and 13% large ulcers at diagnostic endoscopy. At the end of follow-up, 24% were exposed to thiopurines, 18% to biologicals and 4% were colectomized. The need for thiopurines, biological agents or colectomy was independently associated with extensive UC at diagnosis (OR 5.3; IC95% 1.6-17.2), the need for corticosteroids at disease onset (OR 7.8; IC95% 2.6-23.9) and proximal progression during follow-up (OR 13; IC95% 2.3-73.4).

Conclusions: Less than a third of patients with UC use thiopurines or biological agents within the first five years of disease course. Unfortunately, there are no predictive factors robust enough to allow for the early introduction of advanced therapies at disease onset.