Confocal Laser Endomicroscopy Reveals Differential Response in Patients with Active Ulcerative Colitis Undergoing Anti-Integrin Compared to Anti-Tnf-Alpha Therapy

Aims Mucosal healing is the central goal of therapy in ulcerative colitis(UC) but is only based on superficial criteria that do not allow assessment of early therapy response. Confocal Laserendomicroscopy(CLE) enables visualisation of dynamic changes of the mucosa and might reliably exhibit very early changes of the architecture. To evaluate CLE for dynamic quantification of the level of inflammation in UC patients undergoing biological therapy (Vedolizumab(VDO) or Infliximab(IFX)) as a marker for early therapy response.

Methods 90 patients(54m) with active UC underwent probe based CLE (Cellvizio) in the sigmoid at baseline/2/4/6/14 weeks(wk) after initiation of therapy with IFX(N = 46) or VDO(N = 44). CLE criteria were: Mucosal barrier dysfunction, vascular alteration, changes of crypt architecture. Data were correlated to eMayo scores and histological activity indices.

Results Response to therapy was achieved in 73.9 % of IFX and 70.5 % of VDO patients. At baseline, fluorescein accumulated in the mucosa after 8.9±6.1sec, in patients with later response to therapy time to accumulation significantly decelerated within 2 wk to 14.8 ± 5.2sec, without response 9.6±5.4sec.; p=0.03. Capillary diameters were dilated up to 16.3 ± 3.2µm prior to therapies, but decreased in case of therapy response by 20.2 % (13.65 ± 3.2µm, p = 0.001) within 2 wk.Crypts were significantly enlarged up to a diameter of 114.1 ± 21.2µm at baseline and showed a significant shrinkage in response to therapy (92.9±12.3µm; p=0.01). Endoscopic Mayo score revealed no differences at wk 2 between responders/non-responders. CLE changes were markedly higher in the IFX group compared to the VDO groups after 2 wk of treatment. Thereafter, no significant changes were observed between the groups.

Conclusions Dynamic pCLE criteria allow a reliable quantification of the level of inflammation in UC and predict therapy response after 2 wk of treatment that precede mucosal healing significantly. Dynamic, intramucosal changes occur significantly earlier in patients undergoing IFX therapy compared to VDO.

Citation: Ellrichmann M, Schulte B, Bethge J et al. OP181 CONFOCAL LASER ENDOMICROSCOPY REVEALS DIFFERENTIAL RESPONSE IN PATIENTS WITH ACTIVE ULCERATIVE COLITIS UNDERGOING ANTI-INTEGRIN COMPARED TO ANTI-TNF-ALPHA THERAPY. Endoscopy 2021; 53: S74.

Publication History

Article published online:
19 March 2021