P1181 Liver fibrosis predicts response to advanced therapy in inflammatory bowel disease: a new personalized treatment approach?
Authors: Bencardino S , D’Amico F , Barà R , Allocca M , Zilli A , Furfaro F , Parigi T L , Ungaro F , Fiorino G , Peyrin-Biroulet L , Massimino L , Danese S , Moschetta A 
Published: January 2025

Background

Crohn's disease (CD) and ulcerative colitis (UC) are chronic and progressive inflammatory bowel diseases (IBD). It is estimated that up to 30-50% of patients with IBD develop intestinal fibrosis leading to complications such as strictures. Liver fibrosis occurs up to 16.7% of patients with IBD. However, the impact of liver fibrosis on the response to therapy in patients with IBD is unknown. Our aim was to investigate the association between liver fibrosis before starting an advanced therapy and response to treatment in IBD.

Methods

We conducted a retrospective analysis of data that were prospectively gathered from consecutive patients with a confirmed diagnosis of UC or CD, spanning from November 2021 to December 2023. All patients who started an advanced therapy (biological therapy and small molecule drugs) and had transaminase concentrations, body mass index (BMI), history of diabetes, and platelet counts available were eligible. Several scores of liver fibrosis were measured including AST/ALT ratio (AAR), AAR platelet ratio index (AARPRI)1, AST to platelet ratio index (APRI), body mass index AST/ALT ratio and diabetes mellitus score (BARD), fibrosis index based on four factors (FIB -4)2, and modified FIB-4 (m-FIB4)3. All available clinical (partial Mayo score, PMS, for UC and Harvey-Bradshaw index, HBI, for CD), biochemical (fecal calprotectin, FC), and endoscopic (endoscopic Mayo score for UC and simple endoscopic score for Crohn's Disease (SES-CD) and Rutgeert’s score for CD) data at 6 months were collected. A logistic regression multivariate analysis was performed to identify any correlation between scores of liver fibrosis at baseline and response to advanced therapies. Analyses were subjected to correction using the false discovery rate (FDR) method.

Results

In total, 122 patients were included in the analysis. Patient key demographic and treatment information as well as clinical remission, FC normalization and endoscopic remission at 6 months are summarized in table. Two UC patients (2.7%) were hospitalized. Five patients (4.1%) underwent surgery (2 UC-related and 3 CD related). No cases of neoplasia or death occurred. In the multivariate analysis, mFIB-4 at baseline was a predictor of clinical activity at 6 months in CD (FDR=0.08), while AARPRI at baseline predicted clinical activity at 6 months in UC (FDR=0.08) (Figure).

Conclusion

Patients with IBD and concomitant liver fibrosis have a lower rate of clinical remission after 6 months of advanced therapy. Scores of liver fibrosis could predict the response to therapy. Further prospective studies are warranted to implement their use in clinical practice

References

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3.Wang HW, Peng CY, Lai HC, et al. New noninvasive index for predicting liver fibrosis in Asian patients with chronic viral hepatitis. Sci Rep. 2017;7(1):3259. doi:10.1038/s41598-017-03589-w