Management of proctitis in ulcerative colitis and the place of biological therapies

Figures & data

Figure 1. The Montreal classification of ulcerative colitis.

According to the Montreal classification ulcerative colitis can be subdivided into ulcerative proctitis (E1), with involvement limited to rectum/rectosigmoid junction, left-sided ulcerative colitis (E2), with involvement limited to a portion of colorectum distal to splenic flexure, and extensive ulcerative colitis (E3), with involvement extends proximally to splenic flexure.

Table 1. Risk factors positively related to proximal disease extension in ulcerative proctitis.

Risk factor	Odds ratio (OR)/ Hazard ratio (HR) (95% CI)	P value
Obesity (BMI ≥30 kg/m^2) [26]	HR 2.77 (1.07–7.14)	0.03
Previous appendectomy [26]	HR 2.74 (1.07–7.01)	0.04
Endoscopic disease activity [27]	HR 1.96 (1.05–3.67)	0.03
Treatment with systemic steroids [27]	OR 2.077 (1.359–3.174)	0.001
Treatment with any steroids [27]	OR 1.533 (0.984–2.388)	0.059
Treatment with immunomodulators [27]	OR 1.647 (1.119–2.424)	0.011
Treatment with TNF-α antagonists [27]	OR 1.668 (1.077–2.581)	0.022
Treatment with calcineurin inhibitors [27]	OR 3.159 (1.679–5.943)	<0.001
≥1 Flare(s) after first year [13]	OR 5.33 (1.55–18.23)	0.008
Longer endoscopic follow-up [13]	OR 1.01 (1–1.02)	0.015

Table 2. Biological and small molecules treatments in patients with ulcerative proctitis.

Authors	Type of study	Treatment	Patients (n)	Primary endpoint	Median follow-up (months)
Bouguen et al. [81]	Retrospective, multicentre	Infliximab	13	Clinical, and endoscopic efficacy	17
Pineton De Chambrun et al. [82]	Retrospective, cohort	Infliximab, adalimumab, golimumab	104	Clinical response	24
Dubois et al. [18]	Retrospective, monocentre	Infliximab, adalimumab, golimumab	26	Clinical response	21
Dubois et al. [18]	Retrospective, monocentre	Vedolizumab	15	Clinical response	11
Uzzan et al. [83]	Retrospective, multicentre	Tofacitinib	35	Steroid-free remission	12
Lemmens et al. [84]	Retrospective, multicentre	Adalimumab, golimumab, infliximab, ustekinumab, vedolizumab, tofacitinib	167	Short-term steroid-free remission	13.7
Sandborn et al. [85]	Two multicentre, placebo-controlled, phase 3 trials	Etrasimod	52, 12	Clinical remission	13, 3

Figure 2. A proposed management algorithm for ulcerative proctitis.

A treat-to-target management algorithm for ulcerative proctitis is provided.

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