P297 The Toronto IBD Global Endoscopic Reporting (TIGER) Score and its Ability to Predict Outcomes Regarding Steroid and Biologic Use in Ulcerative Colitis and Crohn’s Disease Patients – A Construct Validation Study
Zittan, E.(1,2,3)*;Levy, M.(1,2);Saban , L.(1); Vered, S.(4); Steinhart, A.H.(5); Milgrom, R.(5); Gralnek, I.M.(1,2); Silverberg, M.S.(5); Zelber-Sagi, S.(3);
(1)Emek Medical Center, The Abraham and Sonia Rochlin IBD Unit- Department of Gastroenterology and Liver Diseases, Afula, Israel;(2)Technion-Israel Institute of Technology, The Rappaport Faculty of Medicine, Haifa, Israel;(3)Haifa University, School of Public Health- Faculty of Social Welfare and Health Sciences, Haifa, Israel;(4)Haifa University, Department of Statistics, Haifa, Israel;(5)Mount Sinai Hospital- Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology & Hepatology- Department of Medicine- University of Toronto, Toronto, Canada;
The recently developed TIGER endoscopy score was established to reliably describe disease severity as it can be utilized for both Ulcerative Colitis (UC) and Crohn’s disease (CD) patients.1The aim of this prospective study was to assess the TIGER score’s ability to predict UC and CD patient outcomes including biologic and steroid use.
A cohort of 78 patients with UC (n=40) and CD (n=38) were included in a 52-week multiple visit prospective study. Each visit included patient interviews using the IBD disk questionnaire, blood draws for C-reactive protein (CRP), and fecal calprotectin (FC). Endoscopy assessment was performed at baseline. Administration of steroids, immunomodulators (IMN), biologics, and dose escalations were recorded. Baseline total TIGER scores were dichotomized as <100 points (remission-mild endoscopic activity) or ≥100 points (moderate-severe endoscopic activity) as a predictor of therapeutic outcomes.
At baseline, compared to patients with TIGER scores <100, UC patients with TIGER scores ≥100 had significantly higher CRP (p<0.0005), FC (p<0.0001), and IBD disk (p<0.0001). In CD patients, at baseline, compared to patients with TIGER scores <100, patients with TIGER scores ≥100 had significantly higher CRP (p<0.0006), FC ( p<0.006), and IBD disk ( p<0.0001). At 52-weeks, compared to patients with baseline TIGER scores <100, UC and CD patients with baseline TIGER scores ≥100 had a significantly increased likelihood of requiring steroids as therapy (p<0.0001). Specifically, 7.1% and 0% of UC and CD patients with baseline TIGER scores <100 required steroids compared to 73.1% and 48.3% of UC and CD patients with baseline TIGER scores ≥100, respectively. Moreover, at 52-weeks, compared to patients with baseline TIGER scores <100, UC and CD patients with baseline TIGER scores >100 both had a significantly increased likelihood of being prescribed or having to subsequently escalate biologic therapy (p<0.0001). More specifically, 7.1% and 11.1% of UC and CD patients with baseline TIGER scores <100 required biologic therapy compared to 92.3% and 100% of UC and CD patients with baseline TIGER scores ≥100, respectively.
The TIGER endoscopy score demonstrates significant association with CRP, FC and IBD disk in UC and CD patients. Moreover, the TIGER endoscopy score can be utilized as a measure to predict the likelihood of UC and CD patients with moderate-to-severe disease burden requiring certain therapeutic interventions. These data suggest that the TIGER score reflects disease burden and the subsequent need for pharmacologic intervention in both UC and CD patients.
1. Zittan E, et al. J Crohns Colitis 2022;16:544-553.