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Abstract
Background
Bowel urgency is commonly experienced by patients with ulcerative colitis (UC) and is associated with reduced health-related quality of life (QoL). Mirikizumab, a humanized monoclonal antibody directed against the p19 subunit of IL-23, significantly reduced bowel urgency in a double-blind, randomized, placebo-controlled Phase 2 clinical trial in patients with moderate-to-severe UC (NCT02589665).
Methods
All patients (N = 249) reported symptoms including absence or presence of bowel urgency. Absence of urgency was defined as no urgency for the 3 consecutive days prior to each scheduled visit. Missing urgency data were imputed as present. After 12 weeks of induction treatment, patients who achieved clinical response continued maintenance mirikizumab treatment through Week 52. We assessed the relationship of urgency with QoL, clinical outcomes, and inflammatory biomarkers at Weeks 12 and 52.
Results
Patients with absence of urgency demonstrated significantly greater improvement in Inflammatory Bowel Disease Questionnaire (IBDQ) scores even after adjusting for rectal bleeding (RB) and stool frequency (SF), significantly higher rates of all clinical outcomes at Weeks 12 and 52, and a greater decrease in inflammatory biomarkers C-reactive protein and fecal calprotectin compared to those with presence of urgency. Absence of urgency at Week 12 was associated with improved IBDQ scores at Week 52, while Week 12 RB or SF status was not.
Conclusions
Absence of urgency is strongly associated with improvement in QoL as well as clinical measures of UC disease activity. These findings suggest urgency may be a useful surrogate marker of disease activity and an important treatment target for UC.
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Details
1 * Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai , New York, New York , USA
2 Division of Gastroenterology and Hepatology, University of Calgary , Calgary, Alberta , Canada
3 Division of Gastroenterology and Hepatology, University of Pennsylvania , Philadelphia, Pennsylvania , USA
4 Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai , New York, New York , USA
5 Department of Gastroenterology, Kitasato Institute Hospital Center for Advanced IBD Research and Treatment , Minato-ku, Tokyo , Japan
6 Division of Gastroenterology, University of Washington Medical Center , Seattle, Washington , USA
7 Eli Lilly and Company , Indianapolis, Indiana USA
8 Nuffield Department of Medicine , Oxford University Hospital, Oxford , UK