S13 Case Series: Upadacitinib as a Treatment for Crohn’s Disease

Abstract

Background:The endoscopic Mayo score (MS) is the most frequent score used for the evaluation of inflammatory activity in Ulcerative Colitis (UC), varying from 0 to 3 points. Recently the DUBLIN score (DS) emerged, which varies from 0 to 9 points and results from the product of the MS and the disease extent, according to Montreal classification, E1-E3. In this study we aimed to evaluate and compare the predictive ability of MS and DS for long term treatment failure. Methods: A retrospective and unicentric study was conducted, including patients with left-sided or extensive UC, asymptomatic and without the need for steroid therapy or therapy changes in the 6 months prior to undergoing total colonoscopy with calculation of MS and DS. Treatment failure was evaluated, defined by the need for therapy changes and/or hospitalization because of disease exacerbation, over a follow-up period of a minimum of 24 months and a maximum of 84 months. Results: A total of 204 patients were included, 104 (51%) females and with a mean age at diagnosis of 36.4 6 12.7 years. In the initial evaluation, 48 (23.5%) were being treated with anti-TNFa medication. The mean values of MS were 1.0 6 1.1 points and of DS were 2.2 6 2.6 points. During follow-up, 32 (15.7%) patients experienced treatment failure and patients initially treated with anti-TNFa medication had 2.3 times higher risk of treatment failure (P 5 0.042). MS values (AUC 0.809; P , 0.001; with sensitivity of 0.938 and specificity of 0.529 for values equal or superior to 1) and DS values (AUC 0.789; P , 0.001; with sensitivity of 0.844 and specificity of 0.581 for values equal or superior to 2) had good discriminative abilities in predicting treatment failure. There were no statistically significant differences in the discriminative ability between both scores (P 5 0.340). Conclusion(s): MS and DS had good discriminative abilities in predicting treatment failure. However, the integration of the disease extent in the DS as a complement of MS in the evaluation of UC was not associated with a higher predictive ability of long term treatment failure.