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Need for therapeutic escalation in patients with refractory ulcerative proctitis: Results from the PROCU study of the ENEIDA registry

2024; Wiley; Volume: 60; Issue: 5 Linguagem: Inglês

10.1111/apt.18133

1365-2036

R Ferreiro-Iglesias, Sol Porto Silva, Sandra Soro Marín, María José Casanova, Míriam Mañosa, Carlos González‐Muñoza, Ruth de Francisco, Berta Caballol, Lara Arias García, Marta Piqueras, Yamile Zabana, Montserrat Rivero, Xavier Calvet, Francisco Mesonero, Pilar Varela Trastoy, Reyes Busta Nistal, Raquel Gómez Perosanz, Pablo Vega, M González-Vivó, Marisa Iborra, Fernando Bermejo, L Madero, Iago Rodríguez‐Lago, María Rodríguez González, Isabel Vera, Ángel Ponferrada Díaz, M Vela, Leyanira Torrealba Medina, Manuel Van Domselaar, Fernando Gomollón, Eva Iglesias, Javier P. Gisbert, Margalida Calafat, A. Giordano, Isabel Pérez‐Martínez, E Ricart, Beatriz Sicilia, Raquel Mena, María Esteve, Coral Rivas, Eduard Brunet, Cristina Fernández, Miguel Ángel de Jorge Turrión, Benito Velayos Jiménez, Marta Quiñones Calvo, Cristina Regueiro Expósito, Lucía Márquez, Pilar Nos, Alicia Granja, Ana Gutiérrez, José Luis Cabriada, Daniel Hervías Cruz, Marta Calvo, Jorge Eduardo Pérez Pérez, Yolanda Rodríguez Díaz, David Busquets Casal, Margarita Menacho, Carles Leal, Alfredo J. Lucendo, Vanesa Royo, Sonsoles Olivares, Begoña Álvarez Herrero, Marta Carrillo‐Palau, Pau Gilabert Álvarez, Noemí Manceñido, Teresa Martínez-Pérez, María Carmen Muñoz Villafranca, Pedro Almela, Federico Argüelles‐Arias, Jesús Legido, Ana Fuentes Coronel, Laura Nieto, Eugeni Domènech, Manuel Barreiro‐de Acosta,

Autoimmune and Inflammatory Disorders

Summary Background Ulcerative proctitis (UP) can have a milder, less aggressive course than left‐sided colitis or extensive colitis. Therefore, immunosuppressants tend to be used less in patients with this condition. Evidence, however, is scarce because these patients are excluded from randomised controlled clinical trials. Our aim was to describe the characteristics of patients with refractory UP and their disease‐related complications, and to identify the need for immunosuppressive therapies. Methods We identified patients with UP from the prospective ENEIDA registry sponsored by the GETECCU. We evaluated socio‐demographic data and complications associated with immunosuppression. We defined immunosuppression as the use of immunomodulators, biologics and/or small molecules. We used logistic regression to identify factors associated with immunosuppressive therapy. Results From a total of 34,716 patients with ulcerative colitis, we identified 6281 (18.1%) with UP; mean ± SD age 53 ± 15 years, average disease duration of 12 ± 9 years. Immunosuppression was prescribed in 11% of patients, 4.2% needed one biologic agent and 1% needed two; 2% of patients required hospitalisation, and 0.5% underwent panproctocolectomy or subtotal colectomy. We identified 0.2% colorectal tumours and 5% extracolonic tumours. Patients with polyarthritis (OR 3.56, 95% CI 1.86–6.69; p < 0.001) required immunosuppressants. Conclusions Among patients with refractory UP, 11% required immunosuppressant therapy, and 4.2% required at least one biologic agent.