Abstract Background A recently published study in patients with ulcerative colitis (UC) showed that reduction in intestinal ultrasound (IUS) parameters were early predictors of endoscopic response to filgotinib, a preferential JAK-1 inhibitor 1. We investigated whether IUS parameters, including shear-wave elastography (SWE) and ultrasonographic scores after 4 weeks of treatment predict long-term treatment persistence. Methods UC patients with confirmed endoscopically active disease (endoscopic Mayo score (EMS) ≥2, extending beyond the rectum) starting with filgotinib 200 mg once daily were included. In the sigmoid colon, one blinded reader assessed IUS parameters including BWT, submucosal thickness, relative submucosal echogenicity (RSE) and SWE. Based on BWT, CDS, bowel wall stratification and fat wrapping three IUS scores were calculated at baseline and week 4 (IBUS-SAS, UC-IUS and Milan ultrasound criteria (MUC)). After 52 weeks, treatment persistence – defined as continuous clinical remission (simple clinical colitis activity index ≤2) without treatment change or escalation – was evaluated. Receiver operating characteristic (ROC) curve analysis was performed, and the optimal cutoff for predicting treatment persistence was selected by maximizing the Youden index. Results In total 23 patients were included in the STEER study; one patient was lost to follow-up after six months. At week 52, 7/22 patients (32%) had treatment persistence, while 15/22 (68%) patients had lost treatment persistence (median time to losing persistence: 126 days IQR 25-290). At week 4 in the sigmoid, a BWT of 3.8mm (Odds ratio (OR) 9.0, 95% CI 0.85-94.90; p = 0.06) or -40% (OR 35.0, 95% CI 2.58-475.31; p = 0.001), IBUS-SAS of 20.5 (OR 35.0, 95% CI 2.58-475.31; p = 0.001) or -66% (OR undefined because of small sample size) and SWE of 32.6 kPa (OR undefined because of small sample size) or + 6% (OR 12.0, 95% CI 1.12-128.84; p = 0.06) predicted treatment persistence (table 2). Conclusion This prospective study shows that BWT, IBUS-SAS and SWE after 4 weeks of treatment with filgotinib are surrogate markers for long-term treatment persistence in UC. Reference: 1 Pruijt MJ, Teichert C, De Voogd FA, Janssen RJ, Löwenberg M, Goetgebuer RL, D’Haens GR, Gecse KB. Kinetics of Intestinal Ultrasound and Shear-wave Elastography to assess early response in Ulcerative Colitis Patients Treated with Filgotinib. J Crohns Colitis. 2025 Oct 28:jjaf185. doi: 10.1093/ecco-jcc/jjaf185. Epub ahead of print. PMID: 41148057. Disclosures: This study received unrestricted research grant support from Alfasigma S.p.A. Conflict of interest: Mr. Teichert, Christoph: No conflict of interest Pruijt, Maarten: No conflict of interest Voogd, Floris: received speaker’s fees from AbbVie, Pfizer and Takeda Janssen, Reimer: No conflict of interest Löwenberg, Mark: No relevant CoI to disclose Goetgebuer, Rogier: received speakers free from Janssen-Cilag BV and Pfizer Inc. D’Haens, Geert: Grant: Pfizer, BMS, Johnson and Johnson, Abbvie, Alimentiv BV, Eli Lilly, Takeda, Prometheus Laboratories Personal Fees: Abbvie, Abivax, Agomab, Alimentiv, Anaptys Bio, AstraZeneca, Bristol Meiers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Exeliom Biosciences, Galapagos, Glaxo Smith Kline, Dr Falk Pharma, Pfizer, Johnson and Johnson, Merck, Mirador, Polpharma, Procise Diagnostics, Prometheus Biosciences, Sorriso Pharma, Spyre, Takeda, Ventyx Gecse, Krisztina B.: Grant: Abbvie, Pfizer Inc, Celltrion and Galapagos/Alfasigma Personal Fees: Consultancy fees from AbbVie, Galapagos, Gilead, Immunic Therapeutics, Janssen Pharmaceuticals, Pfizer Inc., and Takeda and speaker’s honoraria from Celltrion, Eli Lilly, Janssen Pharmaceuticals, Pfizer Inc. and Takeda.
Teichert et al. (Thu,) studied this question.