Pandey Anuja, Achrafie Lea, Kodjamanova Petya, Tencer Tom, Kumar Jinender
Health Economics & Market Access (HEMA), Amaris Consulting Ltd, London, UK.
Health Economics & Market Access (HEMA), Amaris Consulting Ltd, Toronto, Canada.
Curr Med Res Opin. 2022 Sep;38(9):1531-1541. doi: 10.1080/03007995.2022.2081453. Epub 2022 Jun 11.
This systematic literature review (SLR) assessed the effects of endoscopic mucosal healing and histologic remission on clinical, quality-of-life (QoL), and economic outcomes in adults with ulcerative colitis (UC) in the real-world setting.
Literature searches of Embase and MEDLINE (6 July 2020) and conference proceedings (2017-2020) were performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Eligible studies included adults with UC with documented endoscopic mucosal healing or histologic remission. Clinical, QoL, and economic outcomes were extracted and narratively synthesized.
Of 1603 studies screened, 25 met eligibility criteria and collectively included 2813 patients (mean age: 34-60 years). The most commonly reported indices were Mayo endoscopic score (MES) for endoscopic mucosal healing ( = 22, 88%) and Geboes score ( = 5, 20%) for histologic outcomes. The most frequently reported clinical outcome was relapse-free survival ( = 15, 60%). Less commonly reported outcomes were avoidance of colectomy ( = 5, 20%), hospitalization ( = 4, 16%), clinical remission ( = 4, 16%), and steroid-free clinical remission ( = 3, 12%). Most studies reported relapse-free survival rates up to 50% over 6-48 months of follow-up in endoscopic mucosal healing cohorts. Studies reporting results by MES demonstrated higher relapse-free survival rates among patients with MES 0 than with MES 1 (32%-100% vs 26%-86%, respectively). Similarly, patients with histologic remission had better relapse-free survival rates over 12-24 months of follow-up compared with those without histologic remission (72%-91% vs 40%-63%, respectively). Rates of clinical remission, steroid-free remission, hospitalization, and colectomy avoidance were also better among patients with endoscopic mucosal healing and histologic remission. Two studies examining QoL reported endoscopic mucosal healing was associated with improved QoL. No study reported economic outcomes.
This SLR demonstrated consistent evidence of improved clinical outcomes among UC patients with endoscopic mucosal healing and histologic remission.
本系统文献综述（SLR）评估了在现实环境中，内镜下黏膜愈合和组织学缓解对成人溃疡性结肠炎（UC）患者的临床、生活质量（QoL）和经济结局的影响。
根据系统评价和Meta分析的首选报告项目指南，对Embase和MEDLINE（2020年7月6日）以及会议论文集（2017 - 2020年）进行文献检索。符合条件的研究包括有记录显示内镜下黏膜愈合或组织学缓解的成年UC患者。提取临床、QoL和经济结局并进行叙述性综合分析。
在筛选的1603项研究中，25项符合纳入标准，共纳入2813例患者（平均年龄：34 - 60岁）。最常报告的内镜下黏膜愈合指标是梅奥内镜评分（MES）（n = 22，88%），组织学结局指标是格博斯评分（n = 5，20%）。最常报告的临床结局是无复发生存（n = 15，60%）。较少报告的结局是避免结肠切除术（n = 5，20%）、住院（n = 4，16%）、临床缓解（n = 4，16%）和无类固醇临床缓解（n = 3，12%）。大多数研究报告在内镜下黏膜愈合队列中，随访6 - 48个月期间无复发生存率高达50%。按MES报告结果的研究显示，MES为0的患者无复发生存率高于MES为1的患者（分别为32% - 100%和26% - 86%）。同样，与无组织学缓解的患者相比，组织学缓解的患者在12 - 24个月的随访中无复发生存率更高（分别为72% - 91%和40% - 63%）。内镜下黏膜愈合和组织学缓解的患者在临床缓解、无类固醇缓解、住院和避免结肠切除术的发生率方面也更好。两项关于QoL的研究报告内镜下黏膜愈合与QoL改善相关。没有研究报告经济结局。
本SLR表明有一致证据显示，内镜下黏膜愈合和组织学缓解的UC患者临床结局得到改善。
