OBJECTIVES: Endoscopic improvement (Mayo Endoscopic Sub score-MES 0 or 1) and endoscopic remission (Mayo Endoscopic Sub score 0) are recognized as important treatment endpoints in ulcerative colitis (UC). The objective of this analysis was to compare relapse rates in UC patients with MES of 0 or 1.

METHODS: PubMed and Embase databases were searched for English language papers and conference abstracts published through June 25, 2022. Studies were selected for inclusion if patients were treated with biologics or small molecules for Ulcerative Colitis (UC). DerSimonian and Laird (D+L) random-effects meta-analyses were conducted to compare relapse rates in patients who achieved Endoscopic improvement and remission (MES=0 or 1). Inter-study heterogeneity was assessed with Cochrane Q and I2 tests (with significant heterogeneity indicated by P < .10 or I2 ≥ 50%).

RESULTS: A total of 2981 records were identified, of which 16 references met the selection criteria for systematic review. A total of 2104 patients were studied in 6 prospective and 9 retrospective studies Meta-analysis found patients who had MES=0 had a lower relapse rate of 17% versus 33% for patients with MES=1. The overall pooled odd ratio for relapse in MES=0 versus MES=1 cohorts was 0.377 (95% CI-0.288-0.495, Heterogeneity chi-squared = 9.52, z= 7.04 p < 0.01). In prospective studies, the pooled OR was 0.411 (95% CI-0.278, 0.606, p < 0.01). In retrospective studies, the pooled OR was 0.349 (95% CI-0.239, 0.509, p < 0.01).

CONCLUSIONS: Endoscopic remission (MES=0) leads to significantly lower relapse rates compared to MES=1 in ulcerative colitis patients.