Histological healing: should it be considered as a new outcome for ulcerative colitis?

ABSTRACT

Introduction: Currently, mucosal healing is considered as a composite treatment end-point in inflammatory bowel disease (IBD) since it has been demonstrated to improve disease-related outcomes. The definition of mucosal healing has evolved and current evidence suggests that in addition to endoscopic healing the achievement of histological remission (HR) represents a potential novel target in the management of IBD in relation to better long-term disease outcomes.

Areas covered: We aimed to review the current literature on HR in ulcerative colitis and discuss its limitations and advantages when adopting this potential new target as an ultimate treatment outcome in clinical trials and routine clinical practice.

Expert opinion: HR is achievable in UC with different rates in conventional therapies, biological and novel drugs. Targeting HR in UC lowers the risk of hospitalizations, colectomy, and colorectal cancer. HR occurs later than endoscopic remission, longer treatment courses are associated with higher HR assessment. This might imply modifying monitoring time schedules and algorithms. Prospective data are needed to support histological healing as a new treatment target in UC.

KEYWORDS:

• Ulcerative colitis
• Crohn’s disease
• histological healing
• mucosal healing
• inflammation

Article highlights

• Patients who achieve histological remission have a lower risk of hospitalizations, colectomy, and colorectal cancer; this target might be particularly relevant in extensive and long-lasting UC to ameliorate long-term outcomes.

• Pathogenic mechanisms implied in the development of CRC in UC patients are to some extent related to sustained inflammation that can be microscopically present even in patients with endoscopic remission.

• Histopathological scoring indices represent a valid tool for adopting histological remission in daily practice.

• Conventional therapies, anti-TNF, and anti-integrins are efficient in inducing histological remission in UC. Data about vedolizumab reported about 55% of histological remission rate, with a maximal effect for a longer course of treatment; UC patients treated with infliximab have shown histological remission in 58% of the cases after at least 11 months of treatment.

• Prospective data are needed to confirm histological healing as a powerful treatment target in UC.

This box summarizes the key points contained in the article.

Declaration of interest

S Danese has served as a speaker, consultant and advisory board member for Schering- Plough, AbbVie, MSD, UCB Pharma, Ferring, Cellerix, Millenium Takeda, Nycomed, Pharmacosmos, Actelion, Alphawasserman, Genentech, Grunenthal, Pfizer, Astra Zeneca, Novo Nordisk, Cosmo Pharmaceuticals, Vifor and Johnson & Johnson, Nikkiso Europe GMBH, Theravance. G Roda has served as speaker for Abbvie, Takeda, Pfizer. M Argollo has served as a speaker, consultant and advisory board for Abbvie, Janssen, Takeda, Pfizer. LP Biroulet has served as a speaker, consultant and advisory board member for Merck, Abbvie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Hospira/Pfizer, Celltrion, Takeda, Biogaran, Boehringer-Ingelheim, Lilly, HAC- Pharma, Index Pharmaceuticals, Amgen, Sandoz, For- ward Pharma GmbH, Celgene, Biogen, Lycera, Samsung Bioepis, Theravance. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.