59 - Endoscopic Severity Score of Immune-Mediated Colitis Is More Effective in Guiding Medical Treatment Than Clinical Severity Grade

Yinghong Wang, MD, PhD¹, Hamzah Abu-Sbeih, MD², Tenglong Tang, MD³, Malek Shatila, MD¹, David M. Faleck, MD⁴, Jessica Harris, MD⁴, Michael Dougan, MD⁵, Anna Olsson-Brown, MBChB⁶, Douglas B. Johnson, MD⁷, Chanjuan Shi, MD⁷, Petros Grivas, MD⁸, Leonidas Diamantopoulos, MD⁸, Dwight Owen, MD⁹, Clarissa Cassol, MD⁹, Christina Arnold, MD⁹, David Warner, MD¹⁰, Ajjar Alva, MD¹⁰, Nick Powell, MBChB¹¹, Ibraheim Hajir, MBBS¹¹, Enrico De Toni, MD¹², Alexander Philipp, MD¹³, Jessica Philpott, MD, PHD¹⁴, Joseph Sleiman, MD¹⁵, David Pinato, MD¹⁶, Mark Lythgoe, MBBS¹⁶, Shahneen Sandhu, MBBS¹⁷, Alison M. Weppler, MD¹⁷, Andrew Buckle, PhD¹⁷, Ella Daniels, MD¹⁸, Anusha S. Thomas, MD¹, Wei Qiao, PhD^3
1MD Anderson Cancer Center, Houston, TX; ²The University of Missouri, Kansas City, MO; ³The University of Texas MD Anderson Cancer Center, Houston, TX; ⁴Memorial Sloan Kettering Cancer Center, New York, NY; ⁵Massachusetts General Hospital, Boston, MA; ⁶The Clatterbridge Cancer Center, Liverpool, England, United Kingdom; ⁷Vanderbilt University, Nashville, NC; ⁸University of Washington, Seattle, WA; ⁹Ohio State University, Columbus, OH; ¹⁰University of Michigan, Ann Arbor, MI; ¹¹Royal Marsden and GUY’s and St Thomas Hospital, London, England, United Kingdom; ¹²University of Munich, Munich, Mecklenburg-Vorpommern, Germany; ¹³Universität München, Munich, Mecklenburg-Vorpommern, Germany; ¹⁴Cleveland Clinic, Cleveland, OH; ¹⁵University of Pittsburgh Medical Center, Pittsburgh, PA; ¹⁶Imperial College, London, England, United Kingdom; ¹⁷Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; ¹⁸Chelsea and Westminster Hospital, London, England, United Kingdom

Introduction: Endoscopic scoring systems have not been established for immune-mediated colitis (IMC). Previous studies have shown benefits from early endoscopic evaluation, but the value of endoscopy compared to clinical assessment remains uncertain. This study aims to establish an endoscopic scoring system for IMC and explore its utility in predicting the need for selective immunosuppressive therapy (SIT, infliximab or vedolizumab) compared to clinical symptoms severity.

Methods: This is a retrospective study from 14 centers worldwide including 674 patients with IMC who underwent endoscopic evaluation. Ten total endoscopic features were recorded based on endoscopic reports and assigned one point each (erythema, edema, loss of vasculature, friability, erosions, exudate, any ulcers, large ulcers, deep ulcers, ≥ 2 ulcers). The scoring system was devised by measuring the specificity of a selected score cutoff in predicting the need for SIT based on clinical consensus from the study group. IBM SPSS Statistics 26 was used to calculate specificities, Pearson correlations, and generate ROC curves.

Results: We divided the cohort to include a training set and a validation set. In the training set, an endoscopy score (ES) cut-off ≥4 has a specificity of 82.8% across all colitis grades and 96.4% among grade 1 colitis alone to predict SIT use. A cut-off ≥5 showed a specificity of 87.6% and 98.2% respectively. These specificities were comparable to those of the validation sets. In contrast, clinical colitis and diarrhea grading based on Common Terminology Criteria for Adverse Events (CTCAE) was poorly associated with future SIT use (specificities of 27.4% and 12.3% respectively). Moreover, this new scoring system with a cutoff of 4-5 had a numerically higher specificity to a Mayo Endoscopic Score (MES) of 3 when ulcer was a mandatory factor (85%-88.2% vs 74.6%). Early endoscopic evaluation in disease course was associated with early SIT use (p < 0.001, r=0.4084).

Discussion: This is the largest, multi-center study to devise an endoscopic scoring system highlighting the important value of endoscopy in guiding the management of IMC for the first time. The results demonstrated that an ES cutoff ≥4 can achieve a higher specificity in predicting SIT use than clinical symptom grading alone. This study supports early and thorough endoscopic evaluation for IMC and paves the way for future external validation of the described scoring system.



Disclosures:


Yinghong Wang, MD, PhD¹, Hamzah Abu-Sbeih, MD², Tenglong Tang, MD³, Malek Shatila, MD¹, David M. Faleck, MD⁴, Jessica Harris, MD⁴, Michael Dougan, MD⁵, Anna Olsson-Brown, MBChB⁶, Douglas B. Johnson, MD⁷, Chanjuan Shi, MD⁷, Petros Grivas, MD⁸, Leonidas Diamantopoulos, MD⁸, Dwight Owen, MD⁹, Clarissa Cassol, MD⁹, Christina Arnold, MD⁹, David Warner, MD¹⁰, Ajjar Alva, MD¹⁰, Nick Powell, MBChB¹¹, Ibraheim Hajir, MBBS¹¹, Enrico De Toni, MD¹², Alexander Philipp, MD¹³, Jessica Philpott, MD, PHD¹⁴, Joseph Sleiman, MD¹⁵, David Pinato, MD¹⁶, Mark Lythgoe, MBBS¹⁶, Shahneen Sandhu, MBBS¹⁷, Alison M. Weppler, MD¹⁷, Andrew Buckle, PhD¹⁷, Ella Daniels, MD¹⁸, Anusha S. Thomas, MD¹, Wei Qiao, PhD³, 59, Endoscopic Severity Score of Immune-Mediated Colitis Is More Effective in Guiding Medical Treatment Than Clinical Severity Grade, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.