P0842Dynamic changes in clinical response to corticosteroids in Ulcerative Colitis

Abstract Background Corticosteroids have been fundamental in the management of ulcerative colitis (UC) flares, yet many patients do not respond or become corticosteroid-dependent. The evolution of clinical response across successive treatment cycles remains underexplored. This study aimed to analyze the dynamics of corticosteroid response over time and identify associated factors. Methods We conducted a retrospective cohort study including adult patients with UC diagnosed between 1975 and 2023 and treated ≥2 corticosteroid cycles. Response was defined by Partial Mayo Score (PMS) criteria. Transitions between response states across cycles were modeled using a Markov approach to estimate probabilities and identify factors associated with response. Results Out of 571 patients with UC, 201 (35.2%) had received ≥2 corticosteroid courses and were included. Over a median follow-up of 9.8 years (IQR 6.4–21.3) there were 899 corticosteroid cycles (708 78.8% with prednisone), Table 1. During follow-up, 89 patients (44.3%) experienced non-response at some point and 84 (41.8%) developed steroid-dependence. The probability of maintaining a “non-responsive” status through corticosteroid cycles was 37.8% (29.6-46.8%) while complete response persistence was 79.5% (95%CI 75.5-82.9%), Figure 1. Intercurrent enteric infections were identified in 23 (11.4%) patients and were associated with corticosteroid non-response within that flare. Beclomethasone use was associated with non-response in the first cycle compared to prednisone (OR 8.70, 95% CI 3.65–20.71). The presence of extraintestinal manifestations (OR 5.34, 95%CI 1.39–20.45) and greater disease extension (OR 1.57, 95%CI 1.05–2.35) were predictors of complete response to corticosteroids through corticosteroid cycles. Conclusion Corticosteroid response in UC is a dynamic phenomenon. Over a third of non-responders remaining unresponsive in subsequent cycles. Extraintestinal manifestations, corticosteroid type and greater disease extension are associated with an increased likelihood of clinical response to corticosteroids. Conflict of interest: Dr. Orti Cuerva, Marina: No conflict of interest Valenzuela García, Maria Auxiliadora: No conflict of interest Mirabent Moreno, Carlos: No conflict of interest Valdivia Krag, Carlos: No conflict of interest Benítez Cantero, José Manuel: Has served as a speaker, consultant and advisory member for or has received research funding from AbbVie, Janssen, Takeda, Gillead, Celgene, Pfizer, Lilly, Ferring, Faes Farma, Dr. Falk Pharma, Chiesi, and Adacyte, Soto Escribano, Pilar: Has served as a speaker, consultant and advisory member for or has received research funding from AbbVie, Janssen, Takeda, Gillead, Celgene, Pfizer, Lilly, Ferring, Faes Farma, Dr. Falk Pharma, Chiesi, and Adacyte, Marin Pedrosa, Sandra: Has served as a speaker, consultant and advisory member for or has received research funding from AbbVie, Janssen, Takeda, Gillead, Celgene, Pfizer, Lilly, Ferring, Faes Farma, Dr. Falk Pharma, Chiesi, and Adacyte, Iglesias Flores, Eva: Has served as a speaker, consultant and advisory member for or has received research funding from AbbVie, Janssen, Takeda, Gillead, Celgene, Pfizer, Lilly, Ferring, Faes Farma, Dr. Falk Pharma, Chiesi, and Adacyte, Gros, Beatriz: Beatriz Gros has served as a speaker for Abbvie, Johnson and Johnson, Takeda, Roche, Gilead, Pfizer and Galapagos and has served as an advisor for Roche, Gilead, Abbvie, Galapagos and Takeda