Combined Histologic and Endoscopic Improvement Does Not Increase Prognostic Benefit Over Endoscopic Improvement Alone in Ulcerative Colitis

Symptomatic and endoscopic remission are recommended targets in ulcerative colitis (UC) because they are associated with better long-term favorable outcomes. Nevertheless, histologic activity may persist in up to 30% of patients, leading to an increased risk of clinical relapse, steroid use, surgery, and hospitalization. However, histologic remission/healing has yet to be a formal target because there is insufficient evidence regarding its benefit over endoscopic improvement (EI) alone. Thus, the role of combined histologic and endoscopic mucosal improvement (HEMI) has been proposed in clinical trials. The VARSITY trial compared vedolizumab and adalimumab in UC, and in the previous analysis, postinduction histologic improvement (HI; week 14) predicted a one-year outcome.

This post hoc analysis of the VARSITY trial evaluated the prognostic role of HEMI (Mayo endoscopic subscore ≤1 and Geboes score <3.2) compared to EI alone and considered clinical outcomes, patient-reported outcomes, and inflammatory markers of patients achieving postinduction (week 14) and postmaintenance HEMI (week 52). 

Of the 468 patients with one year of data, 166 (35.5%) achieved HEMI and 209 (44.7%) attained EI at postinduction. Patients who achieved HEMI at postinduction and at week 52 had lower disease activity, reduced rectal bleeding and stool frequency, and lower fecal calprotectin and C-reactive protein compared to patients with EI alone. However, there was no difference for achievement of clinical remission, corticosteroid-free remission, and treatment failure at one year.