Int J Colorectal Dis. 2022 Feb;37(2):485-493.doi: 10.1007/s00384-022-04098-7. Epub 2022 Jan 27.

Carsten Schmidt ^1 2, Bernd Bokemeyer ³, Andreas Lügering ⁴, Dominik Bettenworth ⁵, Niels Teich ^6 7, Imma Fischer ⁸, Leonie Hammer ⁹, Stefanie Kolterer ⁹, Stefan Rath ⁹, Andreas Stallmach ¹⁰, EPICOL Study Group

Author information

¹Medical Clinic II, Fulda Hospital, Pacelliallee 4, Fulda, 36043, Germany. carsten.schmidt@klinikum-fulda.de.

²Medical Faculty of the Friedrich Schiller University, Jena, Germany. carsten.schmidt@klinikum-fulda.de.

³Interdisciplinary Crohn and Colitis Centre, Minden, Germany.

⁴MVZ Portal 10, Münster, Germany.

⁵Practice for Internal Medicine, Münster, Germany.

⁶Medical Faculty of the Friedrich Schiller University, Jena, Germany.

⁷Practice for Internal Medicine, Leipzig, Germany.

⁸Biostatistik-Tuebingen, Tübingen, Germany.

⁹Medical Department, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany.

¹⁰Clinic for Internal Medicine IV, Jena University Hospital, Jena, Germany.

Abstract

Purpose: The clinical course of ulcerative colitis (UC) is highly heterogeneous, with 20 to 30% of patients experiencing chronic disease activity requiring immunosuppressive or biologic therapies. The aim of this study was to identify predictors for a complicated disease course in an inception cohort of patients with UC.

Methods: EPICOL was a prospective, observational, inception cohort (UC diagnosis, ≤ 6 months) study in 311 patients with UC who were naive to immunosuppressants (IS)/biologics. A complicated course of disease was defined as the need for IS and/or biologic treatment (here therapy with a TNF-α antagonist) and/or UC-related hospitalisation. Patients were followed up for 24 months.

Results: Of the 307 out of 311 participants (4 patients did not meet the inclusion criteria "confirmed diagnosis of active UC within the last 6 months" (n = 2) and "immunosuppressive-naïve" (n = 2), analysis population), 209 (68.1%) versus 98 (31.9%) had an uncomplicated versus a complicated disease course, respectively. In a multivariate regression analysis, prior use of corticosteroids and prior anaemia were associated with a significantly increased risk for a complicated disease course (2.3- and 1.9-fold increase, respectively; p < 0.001 and p = 0.002). Based on these parameters, a risk model for patient stratification was developed.

Conclusion: Our study identifies anaemia and an early need for corticosteroids as predictors for a complicated course of disease in an inception cohort of patients with UC. By determining these parameters in routine clinical practice, our results may support the identification of patients who might benefit from early escalation of therapy.