One-year dynamics of clinical activity during biologics therapy in patients of ulcerative colitis

Background Longitudinal trajectories and the optimal timing for evaluating clinical activity remains unclear in ulcerative colitis (UC) patients receiving biologics. Methods This study included 2705 UC patients from 5 trials and collected 28 807 records of partial Mayo scores (PMS) from baseline to week 52. Latent class growth mixed model was performed to construct 1-year PMS trajectories. Logistic regression assessed the association between PMS trajectories and 1-year therapeutic outcomes, and endoscopic remission was the primary outcome. Spearman correlation was utilized to identify the timepoints of PMS most correlated with the trajectories. Results Five trajectories of clinical activity were identified, including rapid remission (n = 590, 21.8%), delayed remission (n = 316, 11.7%), mild improvement (n = 748, 27.7%), slow improvement (n = 915, 33.8%), and relapse-fluctuation (n = 136, 5.0%) groups. Endoscopic and histological remission rates exhibited a progressive decline across trajectory groups, with the highest probability in the rapid remission group and sequentially lower probabilities in the delayed remission, mild/slow improvement, and relapse-fluctuation groups (P < .001). Week-20 PMS demonstrated the strongest correlation with clinical activity trajectories (correlation coefficient = 0.7867, P < .001), with an area under curve of 0.9311 (95% CI: 0.9183, 0.9440). Furthermore, week-20 PMS could independently predicted 1-year endoscopic (aOR [95% CI] 0.59 [0.54, 0.65], P < .001) and histological (aOR [95% CI] 0.61 [0.53-0.70], P < .001) remission. Conclusions UC patients receiving biologics would exhibit 5 distinct trajectories of clinical activity. Week 20 is a potential intermediate timepoint for clinical activity assessment to inform long-term outcomes.