Objective:

To evaluate long-term clinical outcomes and risk factors for a disabling disease course in patients with moderate-to-severe ulcerative colitis over a 5-year follow-up.

Approach:

• Study Design: A prospective, multicenter, inception cohort study enrolling patients newly diagnosed with moderate-to-severe UC from 30 academic teaching hospitals in Korea.
• Patient Recruitment: Patients were recruited between August 2014 and February 2017, with diagnosis based on clinical, endoscopic, radiological, and histological criteria.
• Clinical Management: Patients were treated according to standard guidelines for moderate-to-severe UC, including systemic corticosteroids and advanced therapies for refractory cases.
• Outcome Assessment: Clinical outcomes were assessed annually up to 5 years, including clinical response, remission, relapse, disease extension, hospitalization, and colectomy.

Key Findings:

• At 1 year, 58.2% of patients achieved remission or mild endoscopic activity.
• No colectomy or mortality was observed in the first year.
• Long-term outcomes indicate ongoing risk for disabling disease despite initial favorable responses.

Interpretation:

The study highlights the need for long-term monitoring and management strategies for patients with moderate-to-severe UC, as early remission does not guarantee sustained disease control.

Limitations:

• The study may not fully represent the broader population due to its multicenter design and specific inclusion criteria.
• Data on the impact of biologics and small molecules on long-term outcomes are limited.

Conclusion:

The findings underscore the importance of understanding the long-term disease trajectory in moderate-to-severe UC patients in Korea.

Sources:

• Study Registration