In patients with UC in clinical remission with a Mayo endoscopic score of 1, is intensifying immunosuppression or continuing the current maintenance regimen preferred

What is known

- An endoscopic Mayo score of 1 was independently associated with a significantly higher rate of clinical relapse than a score of 0 over one year (OR ~6.4). ¹ - Treatment escalation, including need for immunosuppressant and biologic drugs, was more frequently required in patients with MES 1 than MES 0. ¹ - A meta-analysis compared long-term outcomes of steroid-free remission patients with MES 0 versus MES 1, reflecting ongoing debate over whether MES 0 or 1 should be the target of therapy. ²

What is unknown / caveats

- In ACT 1/2 subanalyses, MES 0 vs 1 showed no difference in symptomatic or steroid-free symptomatic remission among infliximab-treated responders ¹ - No retrieved study directly randomizes or tests intensifying immunosuppression at MES 1 versus continuing maintenance - Prognostic associations come from observational cohorts, not interventional trials - Whether acting on residual MES 1 by escalating therapy improves outcomes is not established by the retrieved evidence.

## References

1. Barreiro-de Acosta M, Vallejo N, de la Iglesia D, Uribarri L, Bastón I, Ferreiro-Iglesias R, Lorenzo A, Domínguez-Muñoz JE. Evaluation of the Risk of Relapse in Ulcerative Colitis According to the Degree of Mucosal Healing (Mayo 0 vs 1): A Longitudinal Cohort Study. J Crohns Colitis. 2016;10:13-9. PMID: 26351390.

2. Viscido A, Valvano M, Stefanelli G, Capannolo A, Castellini C, Onori E, Ciccone A, Vernia F, Latella G. Systematic review and meta-analysis: the advantage of endoscopic Mayo score 0 over 1 in patients with ulcerative colitis. BMC Gastroenterol. 2022. PMID: 35240984.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._