Introduction

Proctitis, a form of ulcerative colitis, is often highly symptomatic and challenging to manage. Data regarding the outcomes of biologic and small molecule therapy (advanced treatment) for patients with UC proctitis are limited, largely because these patients are usually excluded from randomized controlled trials.

Aims & Methods

Our aim was to evaluate the persistence of advanced treatment in patients with UC proctitis. From the Czech national prospective registry of biologic and innovative therapy of inflammatory bowel disease (CREdIT) which contains 9033 patients with IBD, we identified 200 treatment courses of advanced therapy among 167 patients with UC proctitis and ≥3 months follow-up. In this preliminary analysis, we employed mixed-effects Cox regression models to attempt to identify an association between treatment type and time to treatment discontinuation. An individual, medical centre, and time period were added as random effects into the models. To ensure a balance between the groups inverse probability of treatment weighting (IPTW) was used when comparing persistence between anti-tumor necrosis factor inhibitors (anti-TNF) and vedolizumab. We further analysed corticosteroid-free persistence after 6 months of treatment for those observations where this data were available. Missing data of co-variables were imputed using multiple imputation.

Results

Among 200 treatment courses, 78 were with infliximab (39%), 39 with adalimumab (20%), 59 with vedolizumab (30%), 13 with tofacitinib (7%), three each with filgotinib, golimumab, and ustekinumab, and two with upadacitinib. Most of the treatment courses were given as 1^st line (1^st 129, 65%; 2^nd 46, 23%; >2^nd 25, 13%). Concomitant corticosteroids at the start of advanced treatment course were reported in 119 (60%) of cases. Comparison of different treatment types revealed that persistence on vedolizumab was longer than on infliximab in the final adjusted model (Hazard Ratio [HR] 2.33, 95% CI 1.17 - 4.67, p-value=0.017). Moreover, vedolizumab was also more persistent compared with anti-TNF drugs as a group in the IPTW analysis (HR 8.03, 95% CI 2.60 - 24.84, p-value=0.001). Corticosteroid-free persistence at 6 months was found in 31/50 (62%) courses of vedolizumab and 56/97 (58%) courses of anti-TNF treatment. Although vedolizumab did not show greater corticosteroid-free persistence at 6 months than infliximab (HR 1.50, 95% CI 0.56-3.96, p-value=0.417), IPTW analysis revealed that vedolizumab was significantly more corticosteroid-free persistent compared to anti-TNF drugs as a group (HR 9.55, 95% CI 2.90-31.42, p-value=0.001).

Conclusion

Based on data from real clinical practice, the persistence of advanced treatment in UC proctitis seems to be low. Treatment with vedolizumab appears to be more persistent than anti-TNF therapy. However, efficacy data must also be analysed before vedolizumab can be considered preferable.

Disclosure

OH: Lectures/congress fees/consultancy: MSD, Abbvie, Takeda, Nutricia, Sandoz, Eli Lilly
ML: Lectures/congress fee/consultacy: Johnson&Johnson, Celltrion, Abbvie, Takeda, Biogen, Phizer
PD: Lecture fee/consultancy: AbbVie, Pfizer, Takeda, Janssen, Eli-Lilly, Sobi, Celltrion
TV: Lecture fee/consultancy: AbbVie, Takeda
ZS: Lecture fee/consultancy: Takeda
LN: Lecture fee/consultancy: Pfizer, Takeda, Janssen (Johnson and Johnson),Ferring
MB: Lecture fee/consultancy: AbbVie, Pfizer, Takeda, Janssen Cilag, Eli-Lilly, Ferring,
Celltrion, Alfasigma, SOBI, PRO.MED.CS
DD: Lecture fee/consultancy: AbbVie, Pfizer, Takeda, Janssen, Eli-Lilly, Ferring

Introduction

Upadacitinib has shown to be more effective than placebo for treating extraintestinal manifestations (EIM) in post-hoc analyses. However, real-world data on the effectiveness of upadacitinib in patients with inflammatory bowel disease (IBD) and EIMs are lacking.

Aims & Methods

A multicenter, retrospective and observational study was conducted at 19 Spanish hospitals. Patients with IBD and active EIMs when initiating upadacitinib were eligible. The primary outcome was EIM improvement at weeks 8-12. The EIM assessment was based on the physician's subjective evaluation and categorized into clinical remission, partial response, nonresponse and worsening. EIM improvement was defined as either clinical remission or partial response. Axial arthropathy, peripheral arthropathy, pyoderma gangrenosum, erythema nodosum, sweet syndrome, aphthous stomatitis, uveitis, episcleritis, primary sclerosing cholangitis and bronchiectasis were considered. In patient experiencing >1 EIM, all had to be resolved or improved to be considered. If not, the worst outcome was recorded. Patients’ visits were scheduled at weeks 0, 8-12, and 6 months. Multivariate analysis was performed to find factors associated with EIM improvement at w8-12.

Results

A total of 160 patients were included, 120 patients with Crohn’s Disease (75.6%), 90 females (56.3%) with a median age of 46.6 years (IQR 37.9-56.7). Upadacitinib was initiated in one hundred twenty-six (78.8%) patients due to EIMs and luminal activity and 35 patients (21.3%) exclusively due to EIMs. All patients were bio-experienced with 84 patients previously treated with ≥3 biologics (52.5%). Baseline EIMs assessment was for at least 1 EIM in 107 patients (66.9%), 42 patients presented 2 EIMs (26.3%) while 11 patients (6.9%) experienced ≥ 3 EIMs.
At w8-12, 99 patients (61.9%) achieved EIM improvement, 40 patients (25 %) clinical remission, 58 patients (36.9%) partial response, 58 patients (36.5 %) nonresponse and worsening in 3 patients. Patients initiating Upadacitinib due to exclusively active EIMs was associated with EIM improvement at weeks 8-12 (OR 2.99 95% CI 1.06-8.42; p=0.04). IBD clinical remission at w8-12 was achieved in 75 patients (61%).
Evaluation at 6 months was available for 103 patients, 73 patients (70.9%) presented EIM improvement, 41 patients (39.8%) clinical remission, 32 patients (31.1%) partial response, 20 patients (19.4%) nonresponse and 10 patients (9.7%) worsening. IBD clinical remission at 6 months was achieved in 51 patients (62.2%).
During the follow-up, Upadacitinib was ceased in 27 patients (16.9%). Adverse events were detected in 39 patients (24.3%) and 7 patients (4.4%) experienced worsening of previous inactive EIMs.

Conclusion

Upadacitinib was highly effective in the short term for treating bio-experienced patients with active EIMs, particularly for patients without luminal activity

Disclosure

No conflict

Introduction

The need for effective therapies in moderate to severe Crohn's disease (CD) drives the comparative evaluation of biologic treatments. The current work uses an anchored Matching-Adjusted Indirect Comparison (MAIC) to assess the efficacy of guselkumab (GUS) relative to risankizumab (RZB) during the treatment induction phase. This MAIC is using data from five phase 3 placebo-controlled blinded clinical trials (GRAVITI, GALAXI 2, GALAXI 3, ADVANCE, MOTIVATE).

Aims & Methods

Adult patients with moderate to severe CD, as defined in GRAVITI, GALAXI 2/3, ADVANCE and MOTIVATE trials were included. An anchored MAIC was utilized, leveraging placebo as common comparator and following guidance from the National Institute for Health Care Excellence in UK. The analysis aligned pooled individual patient data for GUS with published data for RZB by matching exclusion criteria and patient baseline characteristics that could be treatment effect modifiers (eg Age, Sex, BMI, CDAI, disease location or prior biologic treatment failure). During induction, patients received GUS 200 mg intravenous or 400 mg subcutaneous at weeks 0, 4, and 8 or RZB 600 mg intravenous at weeks 0, 4, and 8. The endpoints of interest were symptomatic endpoints such as clinical remission, PRO-2 remission, clinical response, abdominal pain and stool frequency remission, as well as endoscopic response at week 12, which marks the end of the induction period.

Results

After matching, baseline characteristics were balanced between the GUS and RZB cohorts. In a mixed population of bio-naïve and bio-experienced patients, GUS demonstrated statistically significant results in comparison to RZB for PRO-2 remission, clinical response and abdominal pain remission (table 1). Clinical remission showed a trend in favor of GUS, endoscopic response and stool frequence remission were comparable to RZB. In patients with biologic treatment failure versus the MOTIVATE trial, results had been generally more in favor of GUS, while maintaining positive outcomes seen across mixed populations (ADVANCE & MOTIVATE). Results were also mostly consistent whether analyzing pooled GUS data or individual trials, eg from GRAVITI, against RZB.

Table 1: Results of GUS from pooled GRAVITI, GALAXI 2/3 vs. RZB for induction period at week 12

Endpoint	RE measure	Mixed population (ADVANCE & MOTIVATE)		Bio-failure population (MOTIVATE)
		BC	SA	BC	SA
Clinical response	OR [95%CI]	1.78* [1.06; 2.99]	1.42 [0.76; 2.64]	1.71 [0.82; 3.57]	1.23 [0.49; 3.04]
Endoscopic response	OR [95%CI]	1.05 [0.56; 1.97]	1.05 [0.53; 2.09]	1.57 [0.59; 4.18]	1.56 [0.49; 5.01]
Clinical remission	OR [95%CI]	1.51 [0.84; 2.70]	1.22 [0.60; 2.46]	1.52 [0.65; 3.51]	1.08 [0.39; 3.01]
PRO-2 remission	OR [95%CI]	1.96* [1.13; 3.38]	1.85* [1.03; 3.33]	2.89* [1.29; 6.49]	2.97* [1.11; 7.94]
AP score remission	OR [95%CI]	1.68 [1.00; 2.82]	1.37 [0.75; 2.52]	2.02 [0.97; 4.20]	1.68 [0.69; 4.09]
SF score remission	OR [95%CI]	0.99 [0.62; 1.59]	0.93 [0.55; 1.58]	1.14 [0.59; 2.19]	1.04 [0.48; 2.26]

Footnotes: clinical response= ≥100-point reduction from baseline in CDAI OR CDAI <150; endoscopic response= ≥50% improvement from baseline in SES-CD OR SES-CD ≤2; clinical remission= CDAI <150; PRO-2 remission=AP mean daily score at or below 1 [AP≤1] AND SF mean daily score at or below 3 [SF≤3], and no worsening of AP or SF from baseline; AP score remission=Abdominal Pain mean daily score at or below 1 [AP≤1];
SF score remission= number of liquid or very soft stools mean daily score at or below 3 [SF≤3];
BC=baseline risk-adjusted; SA=sensitivity analysis; *p<0,05

Conclusion

The anchored MAIC analysis demonstrates comparable to even superior efficacy of guselkumab over risankizumab in inducing symptomatic improvements in Crohn's disease patients. It also suggests that subcutaneous induction seems to be preferential over iv induction.

Disclosure

van Sanden S, Trevisan M, Strobl A and Wirth D are employees of J&J Innovative Medicines

Introduction

Upadacitinib, a selective JAK inhibitor, is approved for moderate-to-severe Crohn’s disease (CD). However, real-world data on its effectiveness and safety, particularly in highly refractory populations, remain scarce. The UPITA-Crohn registry was established to evaluate the outcomes of upadacitinib in clinical practice across multiple centers in Andalusia, Spain.

Aims & Methods

This ambispective, multicenter registry included 142 patients with refractory CD treated with upadacitinib in 12 Andalusian hospitals. Clinical and biochemical data were collected at baseline, weeks 12 and 16, and at 6 months. Clinical remission (CR) was defined as a Harvey-Bradshaw Index (HBI) <5; clinical-biochemical remission (CBR) as HBI <5, CRP <5 mg/L, and fecal calprotectin <250 μg/g; and steroid-free remission (SFR) as HBI <5 without corticosteroids from week 12. Outcomes were also analyzed overall and according to prior exposure to advanced therapies.

Results

The UPITA-Crohn registry cohort included 142 patients with refractory Crohn’s disease. The mean age was 40.8 years (range 18–76), with 40% male. The mean disease duration at the time of upadacitinib initiation was 13.3 years (range 1–42), with a mean of 2.7 failed advanced therapies, highlighting a population with longstanding and complex disease. Most patients had ileocolonic involvement (50%), 22% had perianal disease, and 32% had previously undergone resective surgery.
The majority (74.4%) received induction with upadacitinib 45 mg for 12 weeks. At week 12, clinical remission was achieved by 54% of patients, with 15% reaching clinical-biochemical remission. At 6 months, among those still on treatment, 48.3% maintained clinical remission, 16.1% achieved clinical-biochemical remission, and 18.4% achieved steroid-free remission (Table 1).
When stratified by prior therapy, 6-month clinical remission was similar between patients with ≥2 prior advanced therapies (48.5%) and those with only 1 prior therapy (47.4%), with no significant difference. Steroid-free and clinical-biochemical remission rates were also slightly higher among less refractory patients, but differences were modest.
A total of 31 patients (21.8%) discontinued upadacitinib before 6 months, mainly due to primary non-response (70.9%). Adverse events were reported in 21.1% of patients, most commonly infections (9 cases), acne (7), transient transaminase elevation (5), and herpes zoster (2). Seven discontinuations were due to serious adverse events, including thrombosis, stroke, myocardial infarction, fever, and severe infections.

Table 1: Effectiveness Outcomes

Timepoint	Baseline (n=142)	12 Weeks (n=124)	16 Weeks (n=87)	6 Months (n=87)	p¹
Harvey-Bradshaw Index (mean)	8.1	4.1 (<0.001)²	4.0 (<0.001)²	4.2 (<0.001)²	<0.001
CRP (mg/L, mean)	9.7	6.2 (0.031)²	6.1 (0.017)²	5.8 (0.017)²	0.021
Calprotectin (μg/g, mean)	1,323.3	1,099.8 (0.533)²	1,015.2 (0.164)²	1,055.6 (0.238)²	0.149
Clinical Remission (%)	16.7%	54.0% (<0.001)³	50.6% (<0.001)³	48.3% (<0.001)³	-
Clinical-Biochemical Remission (%)	2.1%	15.3% (<0.001)³	13.8% (0.001)³	16.1% (<0.001)³	-
Steroid-Free Remission (%)	-	13.7%	17.2% (0.025)³	18.4% (0.003)³	-
Treatment Discontinuation	-	11/142 (7.7%)	24/142 (16.9%)	31/142 (21.8%)	-

¹ Friedman test for related samples (two-way ANOVA by ranks).
² Pairwise comparisons using the Friedman test.
³ McNemar test for related samples.

Conclusion

Upadacitinib demonstrated meaningful effectiveness and a manageable safety profile in a real-world cohort of refractory Crohn’s disease patients. Notably, clinical remission rates remained stable even in those with multiple prior advanced therapies, suggesting upadacitinib may be a valuable option for patients with limited alternatives.

Introduction

Upadacitinib (UPA) has shown promising results in the pivotal trials, which require validation in clinical practice. Primary aim: To assess the durability of UPA treatment in patients with ulcerative colitis (UC). Secondary aims: To assess the short and long-term effectiveness, dose optimization and response to dosage adjustments, the impact of extraintestinal manifestations (EIM) and immunomediated diseases (IMIDs), and the tolerability of UPA in UC in a real-world setting.

Aims & Methods

Adult patients who started UPA for UC treatment at least 8 weeks prior to data collection and were part of the prospectively maintained ENEIDA registry of GETECCU were included. Patients on concomitant biologic agents or with a history of colectomy were excluded. Patients were followed-up from the first UPA dose until treatment discontinuation or the last visit. Effectiveness analysis was restricted to patients with active disease [Partial Mayo Score (PMS)>2] at UPA initiation. Clinical effectiveness was measured using PMS, and concomitant steroid use was assessed at each visit. Patients who discontinued UPA before their last visit were considered not in remission at subsequent time points (negative imputation).

Results

The study included 168 patients, 89% with active disease; 48% had been previously exposed to JAK inhibitors (JAKi), and 31% to all approved therapeutic targets. Mean time of follow-up was 5.6 months (interquartile range = 2.7-11 months). The proportion of patients under 45 mg/day of UPA was 77% at week 8 and 40% at week 16. A total of 29 patients discontinued treatment during a median follow-up time of 4.3 months. The incidence rate of UPA discontinuation was 27% per patient-year of follow-up, with no significant differences related to prior JAKi exposure (log-rank p-value > 0.05). The main reason for UPA discontinuation was loss of response (34%), with colectomy being the main subsequent treatment (21%). No predictive factors for UPA discontinuation were identified (including severity, number of previous advanced therapies, and prior JAKi exposure). Proportions of patients in steroid-free clinical remission (SFCR) were 67%, 71%, 65%, 60% and 75% at week 8, week 16, month 6, month 12 and month 18, respectively. In multivariate analysis, PMS at baseline [Odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.63-0.98] and previous exposure to JAKi (OR = 0.29, 95%CI = 0.14-0.61) were associated with lower probability of SFCR at week 8. Among 100 patients in SFCR at week 8, 13 (13%) lost response (31% per patient-year), and 10 (77%) of these had dose escalation, with 9 (90%) regaining SFCR. Of 31 patients (18%) with active EIM/IMIDs at the start of UPA, 15 (48%) showed improvement. Adverse events occurred in 45 patients (27%), with hypercholesterolemia being the most common, but no major cardiovascular or thromboembolic events were reported.

Conclusion

This study, the largest of its kind in clinical practice, confirms the short- and long-term benefits and the safety profile of UPA for UC. Although prior JAKi exposure reduced short-term effectiveness, it did not impact drug survival, indicating that UPA could be a viable option even for patients who have experienced JAKi failure.

Disclosure

María Chaparro has served as speaker, consultant or research or education funding from MSD, Abbvie, Hospira, Pfizer, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts Pharma, Biogen, Gilead and Lilly.
Luisa de Castro has received grants for conference attendance from Abbvie, Johnsson and Johnsson, Takeda, Falk and Pfizer. She has received grants or participated as a speaker for Johnsson and Johnsson, Falk and Tillots.
Iago Rodríguez Lago has received financial support for traveling and educational activities from or has served as an advisory board member for Abbvie, Adacyte, Biogen, Celltrion, Chiesi, Faes Farma, Ferring, Fresenius Kabi, Galapagos, Janssen, Lilly, Mirum Pharmaceuticals, MSD, Pfizer, Roche, Takeda, and Tillotts Pharma. Research support from AbbVie. Iago Rodriguez Lago is supported by a research grant from Gobierno Vasco-Eusko Jaurlaritza [Grant No 2020111061].
Carla J. Gargallo-Puyuelo Conflicts with Abbvie, Takeda, Janssen, Ferring, Lilly.
Marisa Iborra reports grants and personal fees from MSD, Janssen, Abbvie, Takeda, Kern and Pfizer, during the conduct of the study.
Manuel Barreiro has served as a speaker, consultant and advisory member for or have received research funding from MSD, AbbVie, Janssen, Kern Pharma, Celltrion, Takeda, Gillead, Celgene, Pfizer, Sandoz, Biogen, Fresenius, Ferring, Faes Farma, Dr. Falk Pharma, Chiesi, Gebro Pharma, Adacyte, Vifor Pharma and Oncostellae.
Ruth de Francisco has received support for conference attendance, and research support from AbbVie, Faes Pharma, Ferring, Janssen, Pfizer, Takeda, and Galapagos.
R Pajares Villarroya has received financial support for educational activities from Takeda.
Trapero Martínez Ana María Conflict of interest; Abbvie, Jansen, Lilly, MSD.
Lara Arias García scientific advice, research support and/or training activities for Abbvie FAES Pharma, Kern Pharma, Ferring and MSD.
Raquel Camargo has received funding for different types of training activities from Johnson&Johnson, Avbbie, Pfizer, Ferring, Falk and Galapagos.
Margalida Calafat has served as a speaker or has received research or education funding or advisory fees from Takeda, Janssen, Faes Farma, Falk, Abbvie, Pfizer, Adacyte Therapeutics, Ferring, Gilead, Kern Pharma, and MSD.
MT Diz-Lois Palomares has received funding for training activities/congresses/lectures: Abbvie, Ferring, Johnson and Johnson, Lilly, Takeda.
F. Bermejo has been a speaker, consultant and advisory member or has received research funding from Abbvie, Takeda, Janssen, Pfizer, Lilly, MSD, Biogen, Amgen, Galapagos, Ferring, Faes Farma, Tillotts Pharma, Chiesi, Vifor Pharma.
Marta Calvo Moya has received support for conference attendance, speaker fees, research support, and consultancy fees from AbbVie, MSD, Takeda, Janssen, Pfizer, Lilly, Shire, Chiesi, DrFalk Pharma, Faes Pharma, Ferring, Kern Pharma, and Tillotts Pharma.
MJ Casanova, has received education funding from Pfizer, Takeda, Janssen, MSD, Dr. Falk, Shire, Ferring, Galápagos and Abbvie.
Francisco Mesonero has received funding for educational activities, conferences and scientific advice/consultations from MSD, AbbVie, Takeda, Janssen, Pfizer, Ferring, Kern Pharma, Dr. Falk Pharma, Celltrion Healthcare, Galapagos, Chiesi, Tillots Pharma and Faes Farma.
Yamile Zabana has received support for conference attendance, speaker fees, research support and consulting fees from: AbbVie, Adacyte, Alfa-Sigma, Almirall, Amgen, Boehringer Ingelheim, Dr Falk Pharma, FAES Pharma, Fresenius Kabi, Ferring, Galapagos, Janssen, J&J, Kern, Lilly, MSD, Otsuka, Pfizer, Sanofi, Shire, Takeda, Tillots.
Mónica Sierra has participated as a speaker and attended courses financed by MSD, Abbvie, Takeda, Pfizer, Lilly, Ferring, Sandoz.
B Caballol has received support for congress and conference attendance, speaker fees, research support or consulting fees from Abbvie, Ferring, Janssen, Pfizer, Takeda, Galapagos, Kern Pharma and Lilly.
Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from MSD, Abbvie, Pfizer, Kern Pharma, Biogen, Mylan, Takeda, Janssen, Roche, Sandoz, Celgene/Bristol Myers, Gilead/Galapagos, Lilly, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, Norgine and Vifor Pharma.

Introduction

Systemic corticosteroids are the first-line treatment for moderate to severe immune checkpoint inhibitor-induced enterocolitis (ICIec). Infliximab (IFX) is recommended for steroid-refractory cases; however, up to 28% of patients do not respond. Repeated-dose IFX regimens may improve outcomes and reduce recurrence, but optimal management strategies remain undefined. Here, we describe a series of patients treated with dashboard-guided IFX for ICIec.

Aims & Methods

A retrospective, descriptive case series was conducted at the IBD clinic of Hospital Universitari Vall d’Hebron between January 2021 and February 2025. The study included adult patients with ICIec who received IFX guided by a pharmacokinetic (pK) model. Demographic and clinical data were collected and analyzed.

Results

The dashboard model was applied in five patients to provide additional guidance for treatment decisions. The median age was 60 years, and three patients were female. The median time between the first immunotherapy dose and development of ICIec was 14.8 weeks. Endoscopy revealed extensive disease in 60% of patients, and 40% also had upper GI involvement. At baseline, 40% had severe inflammation. Median IFX levels at weeks 1 and 2 following the first IFX dose were 23.5 µg/mL and 22.3 µg/mL, respectively. The median interval between the first and second IFX doses was 12 days. Clinical remission was achieved in 4 out of 5 patients (80%). With a median follow-up of 16.7 ± 8 weeks, 4 of 5 patients (80%) remained in clinical remission without ICIec recurrence; one patient died due to an infectious complication.

Conclusion

Dashboard-guided IFX dosing showed benefit in ICIec patients. Use of pharmacokinetic modeling may support more tailored IFX dosing strategies, potentially improving treatment outcomes in a subset of ICIec patients with severe or extensive disease. Prospective studies are needed to better define optimal treatment strategies for ICIec.

Introduction

Active inflammatory bowel disease in pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes. Understanding patterns of disease activity may inform strategies for improving outcomes.

Aims & Methods

A retrospective cohort study was conducted of pregnancies managed through an IBD–antenatal clinic between August 2020 and January 2025. Patients were stratified into 2 groups based on disease activity during pregnancy. Active disease was defined using the Physician Global Assessment, symptoms, and biomarkers (CRP and/or FCP). Disease flare was defined by an increase in symptoms and/or biomarkers from their baseline. Disease activity was assessed pre-conception (within 6 months before pregnancy) during pregnancy and post-partum (up to 6 months post birth).

Results

Of 209 pregnancies (Table 1), 76.3% (n=158) were in remission and 23.7% (n=49) had active disease pre-conception. Among those with active disease, 81.6% (n=40) remained active into pregnancy, while 18.4% (n=9) achieved remission. Of those in remission at pre-conception, 73.4% (n=116) stayed in remission during pregnancy, and 24.7% (n=39) flared. 2 patients with no pre-conception data were active in pregnancy.
Of 125 patients in remission during pregnancy, 73.6% (n=92) stayed in remission post-partum and 12.0% (n=15) flared. Among 81 patients with active disease in pregnancy, 39.5% (n=32) remained active, and 53.0% (n=43) achieved remission post-partum.
Patients in remission through pregnancy had a higher mean BMI (24.5 vs 23.0 kg/m², p=0.027), were more likely to be of white ethnicity compared to minority ethnic groups (61.0% vs 38.4% p=0.0026), have a diagnosis of Crohn’s disease (58.6% vs 37.0%, p=0.0088), and be nulliparous (51.2% vs 35.0%, p=0.0414).
At conception, approximately 30% of patients in both groups were not receiving any treatment. During pregnancy, this proportion fell to 8.6% in the active group, reflecting therapy escalation. Use of biologics increased from 22.2% to 38.2% in the active group and remained stable at 36.0% in the remission group. Corticosteroid use was exclusive to the active disease cohort (6.2% at conception; 23.5% during pregnancy).
Active disease in pregnancy was associated with higher rates of adverse outcomes: gestational diabetes (12.3% vs 8.0%, p=0.001), fetal growth restriction (4.9% vs 0%, p=0.044), and low birth weight (<2500g: 14.6% vs 2.4%, p=0.015). While rates of small for gestational age infants were higher in the active group (9.9% vs 4.0%), this was not statistically significant.
Emergency c-sections were more common in the active group (29.9% vs 15.0%, p=0.03), while elective c-sections were more frequent in the remission group (27.5% vs 13.4%, p = 0.03). Women in remission more often had an intact perineum (63.6% vs 54.7%), while episiotomy was more frequent in those with active disease (18.8% vs 11.7%); both did not reach statistical significance.

	Pre-conception % of available data (n)	Pregnancy % of available data (n)	Post-partum % of available data (n)
Active disease	23.7% (49)	39.3% (81)	25.2% (47)
Remission	76.3% (158)	60.7% (125)	74.2% (135)
Excluded (pregnancy loss)	0	3	3
Missing data points	2	0	24

Conclusion

This study underscores the impact of active IBD on maternal and neonatal outcomes.
Nearly 1 in 4 women in remission at preconception flared during pregnancy. This highlights the need for effective pre-conception counselling, access to disease monitoring tools, multidisciplinary management and timely treatment optimisation to sustain remission during pregnancy.

Disclosure

No disclosures