P0321Ulcerative Colitis Under Therapeutic Withdrawal: What Is the Long-Term Outcome?

Background Therapeutic withdrawal may be considered in selected patients with ulcerative colitis (UC) achieving sustained remission. This study aimed to evaluate the clinical, endoscopic, and prognostic evolution of these patients and to identify predictors of relapse. Methods A retrospective, descriptive, and analytical study was conducted in the Department of Hepato-Gastroenterology over a 35-year period (1990–2025), including 602 patients with UC confirmed by clinical, endoscopic, and histological criteria. Therapeutic withdrawal was defined as the absence of maintenance therapy (5-ASA, immunosuppressants, or biologics), either from diagnosis or after remission. Data were extracted from medical records and analysed using descriptive and comparative methods, with a significance threshold set at p < 0.05. Results Among the 602 included patients, 128 (21.3%) were followed without maintenance therapy. Over a median follow-up of 18 months, 54 patients (42.1%) maintained prolonged remission, while 72 (56.2%) experienced relapse. Among all patients under therapeutic withdrawal (n = 128), 37 (28.9%) developed proximal extension and 40 (31.2%) showed endoscopic worsening (Mayo ≥ 2). Complications included acute severe colitis in 15 cases (11.7%), colectomy in 9 (7.0%), and neoplastic degeneration in 4 (3.1%). Overall mortality was 2% (n = 3), with no excess deaths directly related to UC. During the first 18 months, 44 relapses (61.1%) occurred, mainly in patients with an initial Mayo score ≥ 2 (32/44, 72.7%) and pancolitis (28/44, 63.6%), compared with those with a Mayo ≤ 1 or distal disease (p < 0.05). In univariate analysis, predictors of relapse included male sex (42/72, 58%, p = 0.04), younger age at diagnosis (32 vs 40 years, p = 0.03), and shorter remission duration before therapeutic withdrawal (18 vs 36 months, p = 0.02). Patients achieving complete endoscopic remission (Mayo ≤ 1) had a significantly lower risk of relapse (HR = 0.38; 95% CI [0.20–0.71]; p < 0.01). Conclusion Our findings suggest that a reasoned and durable therapeutic withdrawal may represent a feasible management option for selected UC patients in prolonged remission. However, due to the potential risk of unfavourable evolution, close clinical and endoscopic follow-up remains essential. Conflict of interest: Ms. Nohaila, Sardi: No conflict of interest Lagdali, Nawal: No conflict of interest Sabbah, Selma: No conflict of interest Kadiri, maryeme: No conflict of interest Chabib, Fatima-Zahra: No conflict of interest Borahma, Mohammed: No conflict of interest Ajana, Fatima Zohra: No conflict of interest