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. 2024 Sep;60(5):604-612.
doi: 10.1111/apt.18133. Epub 2024 Jun 28.

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

Rocío Ferreiro-Iglesias  1 , Sol Porto Silva  1 , Sandra Marín  2 , María José Casanova  3 , Míriam Mañosa  4 , Carlos González-Muñoza  5 , Ruth de Francisco  6 , Berta Caballol  7 , Lara Arias  8 , Marta Piqueras  9 , Yamile Zabana  10   11 , Montserrat Rivero  12 , Xavier Calvet  11   13 , Francisco Mesonero  14 , Pilar Varela Trastoy  15 , Reyes Busta Nistal  16 , Raquel Gómez Perosanz  17 , Pablo Vega  18 , Maria Gonzalez-Vivo  19 , Marisa Iborra  20 , Fernando Bermejo  21 , Lucía Madero  22 , Iago Rodríguez-Lago  23 , María Rodríguez Gonzalez  24 , Isabel Vera  25 , Ángel Ponferrada Díaz  26 , Milagros Vela  27 , Leyanira Torrealba Medina  28 , Manuel Van Domselaar  29 , Fernando Gomollón  30 , Eva Iglesias  2 , Javier P Gisbert  3 , Margalida Calafat  4 , Antonio Giordano  5 , Isabel Pérez-Martínez  6 , Elena Ricart  7 , Beatriz Sicilia  8 , Raquel Mena  9 , Maria Esteve  10 , Coral Rivas  11 , Eduard Brunet-Mas  13 , Cristina Fernández  14 , Miguel Ángel de Jorge Turrión  15 , Benito Velayos Jiménez  16 , Marta Quiñones Calvo  17 , Cristina Regueiro Expósito  18 , Lucía Márquez-Mosquera  19 , Pilar Nos  20 , Alicia Granja  21 , Ana Gutiérrez  22 , José Luis Cabriada  23 , Daniel Hervías Cruz  24 , Marta Calvo  25 , Jorge Pérez Pérez  26 , Yolanda Rodríguez Díaz  27 , David Busquets Casal  28 , Margarita Menacho  31 , Carles Leal  32 , Alfredo J Lucendo  33 , Vanesa Royo  34 , Sonsoles Olivares  35 , Begoña Álvarez Herrero  36 , Marta Carrillo-Palau  37 , Pau Gilabert Álvarez  38 , Noemí Manceñido Marcos  39 , Teresa de Jesús Martínez-Pérez  40 , María Carmen Muñoz Villafranca  41 , Pedro Almela  42 , Federico Argüelles-Arias  43 , Jesús Legido  44 , Ana María Fuentes Coronel  45 , Laura Nieto  1 , Eugeni Domènech  4   11 , Manuel Barreiro-de Acosta  1 ; ENEIDA project sponsored by GETECCU
Affiliations

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

Rocío Ferreiro-Iglesias et al. Aliment Pharmacol Ther. 2024 Sep.

Abstract

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.

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