P1166 Factors associated with mesalamine refractory Ulcerative Proctitis requiring advanced medical treatments
T Borkovsky, N A Cohen, L Bannon, A Hirsch, Y Ron, T Thurm, N Maharshak, H LeibovitzhAbstract
Background
Ulcerative proctitis, a subtype of ulcerative colitis (UC) affecting the rectum, that in the vast majority of cases is manageable with mesalamine therapy. However, a sub-group of patients become refractory to such treatment, necessitating advanced systemic therapies. We aimed to assess risk factors associated with the need for advanced therapy in proctitis.
Methods
Demographic and clinical data on patients with proctitis were collected retrospectively in a single tertiary center during 2010 to 2024. Proctitis was defined as maximal disease extent of 20cm from the anal verge. Patients who were prescribed immunomodulatory and/or biological therapy were considered refractory proctitis (R-proctitis). Univariate comparative analysis was used to select the features to be included in a multivariate logistic regression analysis to identify the risk factors associated with for R-proctitis. Two-sided p-value < 0.05 was considered significant.
Results
Two hundred and thirty-one patients were included in the analysis of whom 49 (21.2%) were considered R-proctitis. There were no differences between the mesalamine responsive and R-proctitis groups in terms of gender, baseline smoking status, body mass index and follow-up time (Table 1). Mean time to initiation of advanced treatment in the R-proctitis group was 6.2 ± 5.53 years. Compared to the mesalamine responsive group, patients in the R-proctitis group were younger at diagnosis (28.3 ± 14.7 vs. 34.3 ± 15.3, p=0.01), and their baseline colonoscopy showed higher rates of Mayo endoscopic score (MES) 2-3 (86.9% vs. 57.9%, p=0.04) and more extensive disease in cm from anal verge (12.6 ± 5.7 vs. 9.8 ± 5.4, p=0.01). Higher proportion of patients in the R-proctitis were prescribed with topical steroids (50% vs. 17.2%, p=0.001). In the multivariate model, only the use of rectal steroids was significantly associated with progression to R-proctitis (odds ratio [OR] 5.21, 95% confidence interval [CI] 1.56-17.32, p=0.007), while higher baseline MES 2-3 showed a trend (OR 4.31, 95% CI 0.96-19.32, p=0.056).
Conclusion
In this single center retrospective study, the need to use topical steroids was the only significant predictor to progression to R-proctitis necessitating advanced medical treatment. Our results may help stratify patients with ulcerative proctitis who may need closer follow-up and monitoring.