Need for therapeutic escalation in patients with refractory ulcerative proctitis: Results from the PROCU study of the ENEIDA registry
Authors: Ferreiro‐Iglesias Rocío , Porto Silva Sol , Marín Sandra , Casanova María José , Mañosa Míriam , González‐Muñoza Carlos , de Francisco Ruth , Caballol Berta , Arias Lara , Piqueras Marta , Zabana Yamile , Rivero Montserrat , Calvet Xavier , Mesonero Francisco , Varela Trastoy Pilar , Busta Nistal Reyes , Gómez Perosanz Raquel , Vega Pablo , Gonzalez‐Vivo Maria , Iborra Marisa , Bermejo Fernando , Madero Lucía , Rodríguez‐Lago Iago , Rodríguez Gonzalez María , Vera Isabel , Ponferrada Díaz Ángel , Vela Milagros , Torrealba Medina Leyanira , Van Domselaar Manuel , Gomollón Fernando , Iglesias Eva , Gisbert Javier P. , Calafat Margalida , Giordano Antonio , Pérez‐Martínez Isabel , Ricart Elena , Sicilia Beatriz , Mena Raquel , Esteve Maria , Rivas Coral , Brunet‐Mas Eduard , Fernández Cristina , de Jorge Turrión Miguel Ángel , Velayos Jiménez Benito , Quiñones Calvo Marta , Regueiro Expósito Cristina , Márquez‐Mosquera Lucía , Nos Pilar , Granja Alicia , Gutiérrez Ana , Cabriada José Luis , Hervías Cruz Daniel , Calvo Marta , Pérez Pérez Jorge , Rodríguez Díaz Yolanda , Busquets Casal David , Menacho Margarita , Leal Carles , Lucendo Alfredo J. , Royo Vanesa , Olivares Sonsoles , Álvarez Herrero Begoña , Carrillo‐Palau Marta , Gilabert Álvarez Pau , Manceñido Marcos Noemí , Martínez‐Pérez Teresa de Jesús , Muñoz Villafranca María Carmen , Almela Pedro , Argüelles‐Arias Federico , Legido Jesús , Fuentes Coronel Ana María , Nieto Laura , Domènech Eugeni , Barreiro‐de Acosta Manuel ,   the ENEIDA project sponsored by GETECCU
Published: June 2024

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.