Children with newly diagnosed ulcerative colitis may require additional treatment even after receiving standardized therapy, according to the results of the PROTECT cohort study, which included patients from 29 US and Canadian centers. Those mostly likely to require additional intervention included children with severe disease and those requiring IV corticosteroids. Among the details:

• Researchers used the Pediatric Ulcerative Colitis Activity Index (PUCAI) to measure the effects of treatment.
• Children starting mesalazine initially had activity index of 31.1; those starting oral steroids, 50.4, and on IV steroids, 66.9.
• In patients on mesalazine, corticosteroid-free remission at 12 weeks was reached by 48%.
• Steroid free remission was achieved in 33% of patients on oral corticosteroids, and 21% in IV steroids.
• Treatment escalation at 12 weeks among patients on IV steroids was predicted by the following: a baseline Mayo score of 11 or higher, rectal biopsy eosinophil count at or below 32 cells/high power field, rectal biopsy surface villiform changes, and not remitting by week 4.