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Oral Paper Presentation

Annual Scientific Meeting

Session: Plenary Session 2B - Small Intestine / IBD

36 - Monitoring IBD by Intestinal Ultrasound Decreases Time to Treatment Change and Time to Remission in Comparison to Conventional Management

Tuesday, October 24, 2023
9:50 AM - 10:00 AM PT
Location: Ballroom B
ACG Award Winner Livestream ACG Newsworthy Abstract
Award: Outstanding Research Award in the IBD Category

Noa Krugliak Cleveland, MD1, Emma A. Picker, BA1, Natalie K. Choi, BA1, Scott Friedberg, MD2, David K.. Choi, PharmD1, David T. Rubin, MD, FACG1
1University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL; 2University of Chicago, Chicago, IL

Introduction: Intestinal ultrasound (IUS) is a non-invasive, repeatable, and accurate disease monitoring modality that can provide real-time assessment of inflammatory bowel disease (IBD). It has been integrated into routine care for many patients (pts) at our center. Using our prospective upadacitinib (UPA) IBD cohort (Friedberg, CGH 2023), we assessed the impact of IUS on management of our IBD pts.

Methods: We performed a retrospective analysis of UPA-treated patients and assessed the time to treatment change (primary endpoint) and clinical remission (secondary endpoint) in pts receiving routine IUS monitoring compared with pts who did not receive this approach (conventional management). Conventional or IUS disease monitoring included routine clinical care driven by the MD or the pt. Clinical remission was defined by Simple Clinical Colitis Activity Index (SCCAI) ≤2, or Harvey-Bradshaw Index (HBI) ≤4, and by IUS as bowel wall thickness (BWT) ≤3 mm in the colon or terminal ileum and no hyperemia by color Doppler signal (CDS). Pt and disease demographics were obtained. Matching by IBD type and provider was performed.

Results: 105 pts received UPA for treatment of IBD. Pts included in this analysis had at least 24 weeks of follow-up; all received 8 weeks of labeled induction dosing of UPA 45 mg/d, so all pts in this analysis were those who had not achieved clinical remission by week 8. 20 pts were included in this analysis with 30 clinical evaluations (11=IUS, 19=Non-IUS). In IUS pts, the average time to treatment change was 1.1 (±4.1) days post-induction compared to 16.6 (±17.1) days in non-IUS pts. Treatment changes included extended induction with UPA, starting steroids, or starting a different treatment. 5 (71.4%) pts in the IUS-monitoring cohort achieved clinical remission by 26.8 (±15.5) days and 6 (75%) pts in the non-IUS monitoring cohort achieved clinical remission by 55.3 (±39.7) days. Reasons for delay in the conventional group included waiting for test results or endoscopy to be performed, communication between team members and awaiting scheduled visit with a provider. In the IUS group was waiting for a visit with the referring MD.

Discussion: Disease monitoring with IUS in IBD is associated with earlier treatment changes and shorter time to remission compared to conventional approaches to disease monitoring. Ongoing dissemination and incorporation of IUS in the management of IBD are warranted.
 IUS (n = 11)Non-IUS Controls (n = 19)
Age in years, mean (st. dev)44.6 (12.5)31.9 (10.6)
Disease duration in years, mean (st. dev)14 (10.1)11.2 (8.7)
Gender, % (n)  
     Male55.6 (5)72.7 (8)
     Female44.4 (4)27.3 (3)
IBD diagnosis, % (n)  
     Crohn's44.4 (4)54.5 (6)
     UC55.6 (5)45.5 (5)
Disease classification, % (n)  
     E10.0 (0)0.0 (0)
     E225.0 (1)33.3 (1)
     E376.0 (3)66.7 (2)
     L10.0 (0)0.0 (0)
     L20.0 (0)16.7 (1)
     L3100.0 (5)83.3 (5)
     L40.0 (0)0.0 (0)
     B140.0 (2)50.0 (3)
     B240.0 (2)0.0 (0)
     B340.0 (2)50.0 (3)
     Perianal disease20.0 (1)16.7 (1)
SCCAI, mean (st. dev)1.8 (3.3)3.9 (3.5)
HBI, mean (st. dev)3.5 (0.5)8.5 (2.4)
Positive clinical index, % (n)36.4 (4)73.7 (14)
Positive FCP, % (n)36.4 (4)68.4 (13)
Positive IUS, % (n)100.1 (11) 
Active disease, % (n)100.0 (11)100.0 (19)

Table: Table 1. Demographics and Study Findings


Disclosures:
Noa Krugliak Cleveland: Bristol Meyer Squibb – Speakers Bureau. Neurologica – Consultant. Takeda – Consultant.
Emma Picker indicated no relevant financial relationships.
Natalie Choi indicated no relevant financial relationships.
Scott Friedberg indicated no relevant financial relationships.
David Choi: Abbvie – Consultant. Boehringer Ingelheim – Consultant. Bristol Myers Squibb – Consultant. Janssen Pharmaceuticals – Consultant, Speakers Bureau. Prometheus Laboratory – Consultant.
David Rubin: AbbVie, Alimentic Inc., Altrubio, Arena Pharmaceuticals, Aslan Pharmaceuticals, Athos Therapeutics – Consultant. Altrubio – Stock Options. American College of Gastroenterology – Advisory Committee/Board Member. Bellatrix Pharmaceuticals, Boehringer Ingelheim, Ltd., Bristol-Myers Squibb, Celgene Corp/Syneos – Consultant. ClostraBio, Connect BioPharma, EcoR1, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Ironwood Pharmaceuticals – Consultant. Cornerstones Health, Inc. – Cofounder and CFO. Iterative Scopes, Janssen Pharmaceuticals, Lilly USA, LLC, Materia Prima, Pfizer, Prmometheus Biosciences, Takeda, and Techlab, Inc – Consultant. Takeda – Grant/Research Support.


Noa Krugliak Cleveland, MD1, Emma A. Picker, BA1, Natalie K. Choi, BA1, Scott Friedberg, MD2, David K.. Choi, PharmD1, David T. Rubin, MD, FACG1, 36, Monitoring IBD by Intestinal Ultrasound Decreases Time to Treatment Change and Time to Remission in Comparison to Conventional Management, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.