Novel endoscopic scoring system for immune mediated colitis: a multicenter retrospective study of 674 patients - 16/07/24
, Hamzah Abu-Sbeih, MD 1, 2, Tenglong Tang, MD 1, 3, Malek Shatila, MD 1, David Faleck, MD 4, Jessica Harris, MD 4, Michael Dougan, MD, PhD 5, Anna Olsson-Brown, MBChB, PhD 6, Douglas B. Johnson, MD, MSCI 7, Chanjuan Shi, MD, PhD 8, Petros Grivas, MD, PhD 9, Leonidas Diamantopoulos, MD 9, Dwight H. Owen, MD, MSc 10, Clarissa Cassol, MD 11, Christina A. Arnold, MD 12, David E. Warner, MD 13, Ajjai Alva, MD 13, Nick Powell, MBChB, PhD 14, Hajir Ibraheim, MBBS 14, Enrico N. De Toni, MD 15, Alexander B. Philipp, MD 15, Jessica Philpott, MD, PhD 16, Joseph Sleiman, MD 16, 17, Mark Lythgoe, MBBS 18, Ella Daniels, BMBS 19, Shahneen Sandhu, MBBS 20, Alison M. Weppler, MD, MPH 20, Andrew Buckle, PhD 20, David J. Pinato, MD, MRCP (UK), MRes, PhD 18, 21, Anusha Thomas, MD 1, Wei Qiao, PhD 22Abstract |
Background and Aims |
No endoscopic scoring system has been established for immune-mediated colitis (IMC). This study aimed to establish such a system for IMC and explore its utility in guiding future selective immunosuppressive therapy (SIT) use compared to clinical symptoms.
Methods |
This retrospective, international, 14-center study included 674 patients who developed IMC after immunotherapy and underwent endoscopic evaluation. Ten endoscopic features were selected by group consensus and assigned 1 point each to calculate an IMC endoscopic score (IMCES). IMCES cutoffs were chosen to maximize specificity for SIT use. This specificity was compared between IMCESs, and clinical symptoms were graded according to a standardized instrument.
Results |
A total of 309 (45.8%) patients received SIT. IMCES specificity for SIT use was 82.8% with a cutoff of 4. The inclusion of ulceration as a mandatory criterion resulted in higher specificity (85.0% for a cutoff of 4). In comparison, the specificity of a Mayo endoscopic subscore of 3 was 74.6%, and the specificity of clinical symptom grading was much lower at 27.4% and 12.3%, respectively. Early endoscopy was associated with timely SIT use (P < .001; r = 0.4084).
Conclusions |
This is the largest multicenter study to devise an endoscopic scoring system to guide IMC management. An IMCES cutoff of 4 has a higher specificity for SIT use than clinical symptoms, supporting early endoscopic evaluation for IMC.
Le texte complet de cet article est disponible en PDF.Abbreviations : CTCAEv5, IBD, ICI, IMC, IMCES, IQR, irAE, MES, PD-1/PD-L1, ROC, SIT
Plan
Vol 100 - N° 2
P. 273 - août 2024 Retour au numéro
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