TOPLINE

Nearly half of patients with severe immune checkpoint inhibitor (ICI)-induced colitis responded to corticosteroid therapy. Prior oral corticosteroid exposure, endoscopic findings, and higher clinical symptom severity were independent factors associated with treatment failure.

METHODOLOGY

• Researchers conducted a retrospective study promoted by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis to evaluate the efficacy of intravenous corticosteroids and targeted rescue therapies in patients with severe immune-mediated colitis (IMC) and to identify predictors of treatment failure.
• They included 211 patients with solid tumours (mean age, 62 years; 40% women) who received ICIs and needed hospitalisation for grade 3 or 4 IMC from 2014 to 2024 across 43 hospitals in Spain.
• All patients were treated with intravenous corticosteroids at an initial dose of approximately 1 mg/kg/d, with escalation up to 2 mg/kg/d allowed in cases of inadequate response. A total of 94 patients received a first-line advanced therapy as a rescue medical therapy following corticosteroid failure.
• Symptoms were assessed using a modified partial Mayo index score, which included a subscore for abdominal pain; scores ranged from 0 to 3, with 0 indicating absent and 3 indicating severe pain. Endoscopic findings were evaluated using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score.
• Treatment response was defined as clinical improvement sufficient to avoid escalation to rescue medical therapy or surgery on the basis of the physician assessment.

TAKEAWAY

• Overall, 50.2% of patients responded to corticosteroid therapy.
• In multivariate analysis, prior oral corticosteroid use (adjusted odds ratio [aOR], 4.4056; P < .001), a higher UCEIS score (aOR, 1.3136 per point; P = .007), and a higher modified partial Mayo index score including abdominal pain (aOR, 1.4578 per point; P = .002) were independently associated with an increased risk for corticosteroid therapy failure.
• Biologic rescue therapies comprising infliximab (n = 86), vedolizumab (n = 18), and ustekinumab (n = 9) demonstrated comparable effectiveness (65%, 72%, and 67%, respectively).
• Among patients receiving first-line rescue therapies, non-responders had a higher modified partial Mayo index score than responders (6.9 vs 6.1; P = .043).

IN PRACTICE

"[The] study provides clinically relevant insights into the management of severe IMC. As our results show, corticosteroid response is suboptimal, and early identification of patients at high risk of treatment failure is essential," the authors wrote.

"These findings suggest that, in patients presenting with several poor prognostic factors, early initiation of targeted therapy may be warranted, with treatment always individualized to each case," they added.

SOURCE

This study was led by Cristina Polo Cuadro, Servicio de Aparato Digestivo, Instituto de Investigación Sanitaria de Aragón, Hospital Universitario Miguel Servet, Saragossa, Spain. It was published online on July 29, 2026, in Digestive Diseases and Sciences.

LIMITATIONS

The retrospective design may have introduced information bias. The modified partial Mayo index score was not validated previously. Endoscopy data were not available for all patients in the cohort.

DISCLOSURES

One author reported receiving partial funding through a Juan Rodés Grant from Instituto de Salud Carlos III and along with several other authors declared serving as speakers, consultants, and advisory members or receiving research funding and/or financial support for traveling and educational activities from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.