P193 Predicting the middle-term efficacy of molecular-targeted medications for Ulcerative Colitis based on the intestinal ultrasound findings
Miyoshi, J.(1)*;Morikubo, H.(1);Yonezawa, H.(1);Kimura, Y.(1);Moue, C.(1);Komatsu, H.(1);Matsuura, M.(1);Hisamatsu, T.(1);
(1)Kyorin University School of Medicine, Department of Gastroenterology and Hepatology, Mitaka-shi, Japan;
Background
Intestinal ultrasound (IUS) is non-invasive and can assess all segments of the colon even in severe ulcerative colitis (UC). While IUS can estimate the endoscopic findings of UC, in terms of the Treat to Target strategy, it remains a crucial clinical question whether the changes in IUS findings with therapeutic interventions can predict the treatment efficacy and the patient prognosis. Here, we investigated if comparing IUS findings at baseline and 3 months after starting a molecular-targeted medication (MTM) can predict the steroid-free clinical remission (SFCR) of UC at 6 months.
Methods
Inclusion criteria were (1) patients with UC who started an MTM as the induction therapy by March 2022 in Kyorin University Hospital, (2) IUS was performed at baseline and 3 months after starting the medication, and (3) patients could be tracked until 6 months after starting the medication. SFCR was defined as Lichtiger index <4 without changing the MTM, performing surgery, and using steroids. The bowel wall thickness (BWT, mm), bowel wall flow (BWF, scored with Limberg score), bowel wall stratification (BWS, intact/unclear/loss), increased echoic level of mesenteric fat around the colon (i-fat, yes/no), and haustration (normal/abnormal) were assessed at the most severely affected segment of the colon. The change of each parameter (Δ) was evaluated based on the sonographic findings at baseline and 3 months. The changing rate of BWT (ΔBWT%) was calculated as ΔBWT%=100 X ([BWT at 3 months]-[BWT at the baseline])/(BWT at the baseline). Milan ultrasound criteria (MUC) and UC-IUS index (UII) were scored based on the sonographic findings. This study was approved by the Institutional Review Board of Kyorin University School of Medicine (IRB No. 1668).
Results
In total 18 cases (ustekinumab: 7, infliximab: 5, vedolizumab: 4, adalimumab: 1, and tofacitinib: 1) were analyzed. IUS was performed at 0 and 88.5 days (median) after starting the molecular-target medications. Fourteen subjects achieved SFCR at 6 months (SFCR+ group). ΔBWT was significantly better in the SFCR+ group (-1.41±2.90) compared to the SFCR- group (1.20±1.31) (p=0.023). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of ΔBWT for SFCR at 6 months was 0.875. ΔBWT% showed a similar predicting capacity. Apparent sonographic improvements, (1) BWS became intact, (2) i-fat disappeared, and (3) haustration became normal, were observed only in the SFCR+ group. MUC and UII decreased more in the SFCR+ group compared to the SFCR- group, but not statistically significant in the present analysis.
Conclusion
Assessing BWT over time at baseline and 3 months can be a promising index to predict the efficacy of the molecular-targeted medications at 6 months.