Randomised clinical study: discrepancies between patient-reported outcomes and endoscopic appearance in moderate to severe ulcerative colitis

BackgroundAssociations between patient-reported outcomes and mucosal healing have not been established in ulcerative colitis (UC). AimTo evaluate relationships of rectal bleeding and stool frequency with mucosal healing and quality of life (QoL) in patients with UC in two Phase 3 studies (ULTRA 1 and 2). MethodsAssociations of patient-reported rectal bleeding and stool frequency subscores with mucosal healing (Mayo endoscopy subscore=0 or 0/1) and QoL [inflammatory bowel disease questionnaire (IBDQ)] were assessed in adalimumab-randomised patients (160/80mg at Weeks 0/2 followed by 40mg biweekly or weekly) at Weeks 8 (n=433) and 52 (n=299), and in patients with mucosal healing [endoscopy subscore=0 (n=17); 0/1 (n=52)] at Weeks 8 and 52. ResultsAt Week 8, the positive predictive values (PPVs) of rectal bleeding subscore=0, stool frequency subscore=0 or both scores=0 for endoscopy subscore=0/1 were 69%, 84% and 90% respectively; all proportions increased at Week 52. Equivalent PPVs for these subscores in patients with endoscopy subscore=0 were 26%, 37% and 46% respectively. Among patients with endoscopy subscore=0 at Week 8, 87% reported no rectal bleeding, while only 29% reported normal stool frequency; these proportions had increased to 94% and 41% respectively, at Week 52. Among patients with mucosal healing, IBDQ scores trended highest for patients with both rectal bleeding and stool frequency subscores=0. ConclusionsAbsence of rectal bleeding and normal stool frequency are often predictive of mucosal healing and QoL, but complete normalisation of stool frequency is encountered rarely in patients with mucosal healing.