Disease clearance – a new horizon in ulcerative colitis

Abstract

Therapeutic targets in ulcerative colitis have evolved from symptomatic control to a treat-to-target strategy, where endoscopic remission has become a key objective. However, persistent histological activity in patients in endoscopic remission poses a risk of relapse, which has led to the proposal of a new, more ambitious goal – “disease clearance.” This concept represents a composite endpoint comprising of simultaneous achievement of clinical, endoscopic, and histological remission. Growing evidence confirms that achieving “disease clearance” is associated with significantly better long-term outcomes, including a lower risk of hospitalizations and surgery. Furthermore, landmark results from the VERDICT trial have shown that with a treat-to-target strategy using vedolizumab, this stringent target is achievable in up to 67.2% of patients at 48 weeks, particularly when treatment is initiated early. Thus, “disease clearance” represents a new horizon in the management of ulcerative colitis with the potential to alter the natural course of the disease. Although its implementation poses challenges, it shifts the treatment paradigm towards the complete suppression of inflammatory activity and personalized medicine.