P0931Endoscopic responsiveness of the updated Rutgeerts score and its components to treatment in clinical postoperative recurrence

Abstract Background Despite advances in medical therapy, nearly half of patients with Crohn’s disease (CD) still require ileocecal resection. 1, 2 However, up to 70% of patients develop endoscopic postoperative recurrence (ePOR) within the first year after surgery. 3 The aim of our study was to evaluate the responsiveness of the updated Rutgeerts score and its individual components to advanced medical treatment. Methods This retrospective analysis included patients who initiated advanced medical therapy for ePOR based on an index ileocolonoscopy performed within 14 months after resection with ileocolonic anastomosis. All patients underwent at least one follow-up ileocolonoscopy within 14 months after treatment initiation. Procedures were video recorded and scored with the updated Rutgeerts score and a granular assessment of individual anatomical components (anastomotic line, ileal body, ileal inlet and neo-terminal ileum) by a blinded expert endoscopist. ePOR was defined as an updated Rutgeerts score ≥i2b. For each ileocolonoscopy, the most severe lesion at each anatomical location (ulcer aphthoid lesion punctiform lesion; deep superficial) is accounted for the score. Patients with ostomy at the moment of index ileocolonoscopy were excluded. Demographics, disease and surgery characteristics were collected from the electronic medical records. Changes in the updated Rutgeerts score and its granular components were assessed using the Wilcoxon signed-rank and McNemar test. Results Thirty-five patients 60% male, median (interquartile range, IQR) age 40. 8 (31. 7-54. 2) years, index ileocolonoscopy within 6. 31 (6. 08-7. 96) months with ePOR at index ileocolonoscopy were included. All patients initiated advanced medical therapy (12 patients ustekinumab, 12 vedolizumab, 9 adalimumab, 1 infliximab and 1 patient risankizumab) and underwent a follow-up ileocolonoscopy after a median (IQR) of 7. 8 (6. 3-10. 6) months. A significant improvement of the updated Rutgeerts score was observed in 51. 43% of patients (p = 0. 0026). A more detailed analysis of the granular scoring demonstrated that most severe lesion per each anatomical location significantly improved after treatment for ePOR (Table 1). Ulcerative lesions tended to show less improvement after treatment compared with punctiform or aphthoid lesions in segments proximal to the anastomotic line. Conclusion The updated Rutgeerts score and the granular endoscopic score demonstrated responsiveness to therapy, with significant improvement in endoscopic signs of postoperative recurrence and supporting the benefit of advanced medical treatment in this setting. Further validation in a larger, prospective cohort is warranted. References: 1. Rivière P, Bislenghi G, Vermeire S, et al. Postoperative Crohn’s Disease Recurrence: Time to Adapt Endoscopic Recurrence Scores to the Leading Surgical Techniques. Clin Gastroenterol Hepatol. 2022;20 (6): 1201-1204. doi: 10. 1016/j. cgh. 2022. 02. 025 2. Rivière P, Pekow J, Hammoudi N, et al. Comparison of the Risk of Crohn’s Disease Postoperative Recurrence Between Modified Rutgeerts Score i2a and i2b Categories: An Individual Patient Data Meta-analysis. Journal of Crohn’s and Colitis. 2023;17 (2): 269-276. doi: 10. 1093/ecco-jcc/jjac137 3. Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease. Gastroenterology. 1990;99 (4): 956-963. doi: 10. 1016/0016-5085 (90) 90613-6 Conflict of interest: Mr. Simonič, Jože: No conflict of interest Simonič, Polona: No conflict of interest Tyrode, Gaëlle: No conflict of interest Daperno, Marco: Personal Fees: Takeda, Johnson & Johnson, GILEAD, Roche, Pfizer, Abbvie, Ferring, Chiesi, Alfasigma, Celltrion, Sanofi Other: Clinical trials: Takeda, Janssen, Roche Domènech Moral, Eugeni: Personal Fees: I have served as a speaker, or has received research or education funding or advisory fees from AbbVie, Adacyte Therapeutics, Biogen, Celltrion, Gilead, Janssen, Kern Pharma, MSD, Pfizer, Roche, Samsung, Takeda, Tillots. Other: I have served as a speaker, or has received research or education funding or advisory fees from AbbVie, Adacyte Therapeutics, Alfasigma/Galapagos Biogen, Celltrion, Ferring, Gilead, GoodGut, Imidomics, Janssen, Kern Pharma, Lilly, MSD, Pfizer, Roche, Takeda, Tillots. Laharie, David: Personal Fees: Board, consulting and lecture fees from Abbvie, Alfasigma, Amgen, Biocon, Celltrion, Ferring, Fresenius-Kabi, Johnson & Johnson, Lilly, Medac, MSD, Pfizer, Sandoz, Takeda. Mañosa Ciria, Miriam: Personal Fees: AbbVie, Adacyte, Lilly, Janssen, MSD, Pfizer, Kern, Ferring, Faes and Tillots Reinisch, Walter: Personal Fees: WR has served as a speaker for AbbVie, Alfasigma, Celltrion, Ferring, JNJ, Galapagos Medice, Lilly, MSD, Roche, Pfizer, Sobi, Takeda, as a consultant for AbbVie, Agomab, Alfasigma, Alvotech, Amgen, Anaptys Bio, AOP Orphan, Boehringer Ingelheim, Bristol Myers Squibb, Calyx, Celltrion, Eli Lilly, Galapagos, Gilead, Index Pharma, Janssen, Medahead, Merck, Microbiotica, Pfizer, Sanofi, Teva, Takeda as an advisory board member for AbbVie, Alfasigma, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Galapagos, JNJ, Pfizer, Teva and has received research funding from AbbVie, JNJ, Sandoz, Sanofi, Takeda. Guedelha Sabino, João: Speaker’s fees: Lilly, Pfizer, Abbvie, Ferring, Falk, Takeda, Janssen, Fresenius, and Galapagos. Consultancy fees: Takeda, Pfizer, Janssen, Ferring, Fresenius, Abbvie, Galapagos, Celltrion, Pharmacosmos, and Pharmanovia. Research support: Galapagos, Viatris, and Eurogenerics. JS is supported by a Senior Clinical researcher grant from the Research foundation – Flanders. Vermeire, Séverine: Grant: AbbVie, Pfizer, Takeda, J&J, Galapagos Personal Fees: AbbVie - AbolerIS Pharma - AgomAb - Alimentiv - Arena Pharmaceuticals - AstraZeneca - Avaxia- BMS - Boehringer Ingelheim - Celgene - CVasThera - Dr Falk Pharma - Ferring - Galapagos - Genentech-Roche - Gilead - GSK - Hospira - Imidomics - Janssen - J&J - Lilly - Materia Prima - MiroBio - Morphic - MrMHealth - Mundipharma - MSD - Pfizer - Prodigest - Progenity - Promakhos Therapeutics - Prometheus - Robarts Clinical Trials - Second Genome - Shire - Surrozen - Takeda - Theravance - Tillots Pharma AG - Zealand Pharma - Other: AbbVie, MSD, Takeda, Ferring, Genentech/Roche, Shire, Pfizer Inc, Galapagos, Mundipharma, Verstockt, Bram: Research support from AbbVie, Biora Therapeutics, Celltrion, Landos, Pfizer, Sanofi, Sossei Heptares/Nxera and Takeda. Speaker’s fees from Abbvie, Agomab, Alfasigma, Biogen, Bristol Myers Squibb, Celltrion, Eli Lily, Falk, Ferring, Galapagos, Materia Prima, Johnson and Johnson, Pfizer, Sandoz, Takeda, Tillots Pharma, Truvion and Viatris. Consultancy fees from Abbvie, Alfasigma, Alimentiv, Anaptys Bio, Applied Strategic, Astrazeneca, Atheneum, BenevolentAI, Biora Therapeutics, Boxer Capital, Bristol Myers Squibb, Domain Therapeutics, Eli Lily, Galapagos, Guidepont, Landos, Merck, Mirador Therapeutics, Mylan, Nxera, Inotrem, Ipsos, Johnson and Johnson, Pfizer, Sandoz, Sanofi, Santa Ana Bio, Sapphire Therapeutics, Sosei Heptares, Takeda, Tillots Pharma and Viatris. Stock options Vagustim and Thethis Pharma. Riviere, Pauline: Personal Fees: fees or travel support from Abbvie, Celltrion, Janssen, Takeda Ferrante, Marc: Research grants from AbbVie, EG Pharma, Celltrion, Janssen, Pfizer, Takeda and Viatris Consultancy fees from AbbVie, AgomAb Therapeutics, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Janssen-Cilag, MRM Health, Merck Sharp and Dohme, Pfizer, Takeda and ThermoFisher Speakers’ fees from AbbVie, Biogen, Boehringer Ingelheim, Dr Falk Pharma, Ferring, Janssen-Cilag, Merck Sharp and Dohme, Pfizer, Takeda, Truvion Healthcare and Viatris