- Research Article
1
- 10.1093/ecco-jcc/jjaf231.135
DOP098 AI tool distinguishes differences in endoscopic disease activity in ulcerative colitis where humans could not: data from the TITRATE trial
- Jan 01, 2026
- Journal of Crohn’s and Colitis
- K B Gecse + 20 more +20
Abstract Background Endoscopic activity indices for ulcerative colitis (UC) demonstrate limited accuracy, particularly in acute severe UC (ASUC). Artificial intelligence-based scoring (AI) may enhance this. We investigated whether the DovaVision UC AI tool could detect differences in endoscopic response rates between personalised and standard infliximab (IFX) dosing in ASUC patients enrolled in the prospective randomised TITRATE trial, that were previously not detected with human assessment. Methods In TITRATE, adult IFX-naive steroid-refractory ASUC patients were randomised 1:1 to standard dosing (SD) or personalised dosing (PD) with IFX. After an initial 5 mg/kg IFX infusion, patients in the SD group received 5 mg/kg IFX at week 2 and 6. In the PD arm, additional 5 mg/kg IFX infusions were administered guided by a Bayesian pharmacokinetic algorithm (iDose™) aiming to achieve prospectively defined target IFX serum concentrations until day 42. Endoscopies were recorded at baseline and at week 6. Definitions of endoscopic response were ≥2-point improvement in UC endoscopic index of severity (UCEIS) and ≥1-point improvement in Mayo endoscopic subscore (MES) at week 6 compared to baseline. Patients with missing endoscopic data were classified as non-responders. Endoscopic activity was previously scored on blinded videos by 2 independent human experts, with a third for adjudication (1). Here, we applied the DovaVision UC AI tool to the blinded videos. This scored the UCEIS and MES on individual frames and aggregated results to yield final procedure-level scores. Results In total, 48 patients were randomised to PD (n = 23) or SD (n = 25) (Table 1). Human UCEIS or MES assessments could not distinguish differences in response rates (UCEIS: 13 (56.5%) in the PD and 11 (44.0%) in the SD group (p = 0.540); MES: 14 (60.8%) in PD and 10 (40.0%) in SD group (p = 0.250)) (1).Using AI-assessed UCEIS, 27/48 (56.2%) patients achieved endoscopic response, comprising 18/23 (78.3%) in the PD and 9/25 (36.0%) in the SD group (p = 0.004). Using AI-assessed MES, 24/48 patients (50.0%) responded (16/23 (69.6%) in PD and 8/25 (32.0%) in SD group (p = 0.020)) (Figure 1). Conclusion In ASUC patients treated with IFX, the AI tool was able to detect endoscopic response at 6 weeks of IFX treatment, regardless of the endoscopic activity index that was used. The AI tool could also distinguish response rate differences between personalised and standard dosing of IFX. In the original study, human UCEIS or MES assessments could not distinguish such differences. This is the first IBD study in which AI was able to distinguish treatment effects between different treatment strategies, demonstrating its potential to fundamentally improve clinical trial methodology.
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