P3618 - Outcomes of Patients Admitted for Acute Severe Ulcerative Colitis Based on Treatments

Fadl A. Zeineddine, MD¹, Rajdeepsingh Waghela, MD¹, Adam A.. Saleh, BS², Malcolm K. Irani, MD³, Christopher Fan, MD³, Bincy Abraham, MD, MS, FACG³, Kerri Glassner, DO^3
1Houston Methodist Hospital, Houston, TX; ²Texas A&M College of Engineering Medicine, Houston, TX; ³Houston Methodist-Weill Cornell, Houston, TX

Introduction: Patients with ulcerative colitis (UC) who do not respond to intravenous corticosteroids are treated with infliximab (IFX) or cyclosporine. Data on the use of other approved therapies for UC in acute severe UC (ASUC) is limited. Here we describe outcomes of alternate treatment regimens for the treatment of ASUC.

Methods: Patients admitted at a tertiary hospital with endoscopic Mayo 3 UC activity were retrospectively studied. Clinical data, including treatment and adverse events were obtained from records. Measures of central tendency and frequency distribution were used to describe clinical outcomes.

Results: In total, 52 patients (46% males) were admitted with a mean age of 47 years, disease duration of 50 months and average BMI of 26.8 kg/m2. UC treatment naïve patients (n=16) treated with IV steroids (IVS) only (n=13, 81.3%) had a mean hospital stay (HS) of 8.5 days and none required colectomy at 12 months after admission, while those treated with IFX (n=3, 18.7%) had a mean HS of 11 days, with 1 patient requiring colectomy within 7 days due to toxic megacolon. Patients on 5-ASA before admission (n=10) and treated with only IVS (n=7, 70%) had a mean HS of 5.4 days, and none required colectomy at 12 months after hospitalization, while those treated with IFX (n=3, 30%) had a mean HS of 13.3 days, and none required colectomy at 12 months after hospitalization. Patients on IFX prior to admission (n=13), those treated with IVS only (n=4, 30.8%) had a mean HS of 7 days with 1 requiring colectomy within 3 days of admission, while those who continued treatment with IFX (n=8, 61.5%) had a mean HS of 8 days with 1 requiring colectomy after 157 days of admission due to perforation. Additionally, one patient who was treated with upadacitinib inpatient while being on IFX as outpatient had no need for surgery. For those treated with adalimumab prior to admission (n=3), neither who were put on steroid or tofacitinib had the need for colectomy.

Discussion: While our study population was small, patients who were treated with infliximab prior to admission and continued IFX after admission for ASUC had the highest rate of undergoing colectomy. This suggests that patients on infliximab as outpatient or requiring initiation of it as an inpatient could have been sicker population. It is interesting to note that no patients who received JAKi after antiTNFs therapy required colectomy. Larger studies are needed to better determine the efficacy of small molecules and other biologics for ASUC.


Disclosures:


Fadl A. Zeineddine, MD¹, Rajdeepsingh Waghela, MD¹, Adam A.. Saleh, BS², Malcolm K. Irani, MD³, Christopher Fan, MD³, Bincy Abraham, MD, MS, FACG³, Kerri Glassner, DO³. P3618 - Outcomes of Patients Admitted for Acute Severe Ulcerative Colitis Based on Treatments, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.