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P420 Does vedolizumab change mural vascularisation in ulcerative colitis and is there a correlation with endoscopic findings?

D. Klett*, D. Strobel, D. Wildner, R. Atreya, M. F. Neurath, R. S. Görtz

Friedrich-Alexander University Erlangen-Nürnberg, Department of Medicine I, Erlangen, Germany

Background

To improve management of patients with ulcerative colitis (UC), objective measurement of inflammatory activity in sonography are needed. We investigated the change of mural vascularisation by dynamic contrast-enhanced ultrasound (DCEUS) in UC patients undergoing treatment with vedolizumab, an antibody of α4β7 integrin, and the correlation with clinical scores and endoscopic findings.

Methods

In total, 10 patients with UC undergoing therapy with vedolizumab were examined with clinical scoring, blood tests, B-mode sonography, colour Doppler (0, +, ++, +++), endoscopy, and DCEUS at time 0 and 14 weeks after therapy induction. One patient did not approve of endoscopy contemporary to week 0; 2 patients did not approve of endoscopy at week 14. Outcome was defined as a change of the clinical Mayo sub-score, a change of the therapy-regime after week 14 showing therapy failure, or therapy efficacy and an alteration of endoscopic findings (endoscopic Mayo sub-score). The perfusion analysis was performed with a commercially available software program (VueBox™ by Bracco) that analyses the contrast intensity in a selected area, fits the data to a standardised time-intensity curve, and derives several relative perfusion parameters, such as peak enhancement (PE), rise time (RT), and time to peak.

Results

During observation period, 6/10 patients improved clinically (Mayo sub-score Δ ≤ -1) (group 1), whereas 4/10 patients did not improve (group 2). Both bowel wall thickness and colour Doppler decreased in group 1, significance was only given in colour Doppler (p = 0.048). In group 2 both parameters increased. The DCEUS in group 1 showed a slight decrease of PE and an increase of RT, and in contrast in group 2, a slight increase of PE and decrease of RT.

Figure 1. Peak enhancement decreased in group 1 (decrease of clinical Mayo sub-score) and slightly increased in group 2 (no change in clinical Mayo sub-score).

In endoscopy, 4/7 patients had an improvement of endoscopic Mayo sub-scores (group 3), but none of them reached complete endoscopic remission. Further, 2/7 patients showed stable endoscopic scores, and 1 patient showed a deterioration of macroscopic inflammation (group 4). In both groups, a visible change was found in terms of DCEUS parameters (Δ PE) fitting the change of macroscopic findings in endoscopy (Δ endoscopic Mayo sub-score) (PE correlation rs = 0.698; significance p = 0.088).

Conclusion

Colour Doppler and DCEUS could become viable ways to monitor the degree of inflammation in UC patients treated with vedolizumab. Peak enhancement correlates with endoscopic findings.