P1124 Disease Clearence after Acute Severe Ulcerative Colitis episode: is it possible ?
Authors: Markovic S , Kralj Đ , Mitrovic M , Knezevic-Ivanovski T , Kalaba A , Odanovic O , Maksimovic B , Sreckovic S , Svorcan P 
Published: January 2025

Abstract

Background
Acute severe ulcerative colitis (ASUC) is a critical and potentially life-threatening condition necessitating prompt and effective intervention. Long-term follow-up of these patients is vital for understanding the disease trajectory, therapeutic outcomes, and overall patient management. The concept of disease clearance has been proposed as a potential target in ulcerative colitis (UC). This study aims to report one-year follow up data after patients experienced ASUC.

Methods
We performed a retrospective analysis of patients diagnosed with ASUC at our Referral IBD center from 2014 to 2024. Inclusion criteria were based on established clinical parameters in accordance with ASUC. Data collected included patient demographics, disease severity, treatment modalities, surgical interventions, and one-year outcome (disease clearance, mucosal healing, colectomy). Treatment comprised intravenous corticosteroids, followed by immunomodulator (Cyclosporine and biologics) in non-responders.

Results
The study included 109 patients diagnosed with ASUC. The average age at the time of initial presentation with ASUC was 42.1 years, and 47% of the participants (44 out of 109) were male. The mean C-reactive protein (CRP) level recorded was 77.65 mg/L. Among the patients, 36.7% (40 out of 109) were treated with Infliximab, while 14.6% (16 out of 109) received Cyclosporine as rescue therapy. Colectomy was necessary for 12% (14 out of 109) of the patients due to either refractory disease or complications within the first year. The rest of the patients, 44.9 % (49 out of 109) achieved remission on intravenous steroids, and consecutively received either Infliximab (33/49), Vedolizumab (11/49) or Tofacitinib (5/49). Additionally, 7.3% (8 out of 109) achieved clinical remission using intravenous steroids in combination with aminosalycilates. After one year of follow-up, 55% (57 out of 109) of the patients achieved mucosal healing, and disease clearance was observed in 27.5% (30 out of 109) of the cases. 67.5% (27 out of 40) achieving mucosal healing and 45% (18 out of 40) experiencing disease clearance.

Conclusion
Definition of disease clearance was proposed to provide practical recommendations for its implementation as a therapeutic target in UC. Almost one third of our patients achieved DC after ASUC, majority in Infliximab group with colectomy rate of 12 % in first year.

References
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