Remission endpoints in ulcerative colitis: A systematic review

Table 5 Definitions of remission in ulcerative colitis

Guidelines	Definition
FDA[5]	Clinical remission Mayo score of ≤ 2 with no individual subscore > 1 Rectal Bleeding subscore = 0 Stool Frequency subscore = 0 (at least one point decrease in Stool Frequency subscore from baseline and achieved 1 is considered) Endoscopy subscore = (Mayo score: 0 or 1, UCDAI = 0) Clinical response Reduction in Mayo score ≥ 3 and ≥ 30% from baseline with Rectal Bleeding subscore ≤ 1 Corticosteroid-free remission Clinical remission in patients using oral corticosteroids at baseline who have discontinued them and are in clinical remission at the end of the study
World Gastroenterology Organisation	Clinical remission UCDAI ≤ 2 (2010 World Gastroenterology Organisation Practice Guideline)[50] Corticosteroid-free remission Decreasing the frequency and severity of recurrence and reliance on corticosteroids
International Organisation for the Study of IBD	End points = induction of remission = mucosal healing[12] The absence of friability, blood, erosions and ulcers in all visible segments No mention of clinical symptoms
American College of Gastroenterology	No clear definition[51]
British Society of Gastroenterology	No clear definition[52]
European Crohn’s and Colitis Organisation	Remission[53] A complete resolution of symptoms and endoscopic mucosal healing Not been a fully validated definition of remission Suggest the best way forward is a combination of Stool Frequency ≤ 3 No rectal bleeding Normal or quiescence mucosa at endoscopy Clinical response Clinical and endoscopic response depending on the activity index Generally, a decrease in the activity index > 30% plus a decrease in the rectal bleeding and endoscopic subscores

UCDAI: Ulcerative colitis disease activity index; IBD: Inflammatory bowel disease; FDA: Food and Drug Administration.