Different outcomes of AI-read vs human-read endoscopies in the TITRATE study

A post-hoc analysis of the TITRATE study showed that personalised infliximab dosing was superior to standard dosing in patients with acute severe ulcerative colitis (UC) when endoscopies were assessed using an artificial intelligence (AI)- assisted scoring tool. This effect was not observed in the primary analysis, where human readers evaluated endoscopies using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS).

The open-label, randomised controlled TITRATE study (NCT03937609) investigated whether personalised, dashboard-driven infliximab dosing leads to better outcomes than standard induction dosing in patients with steroid-refractory acute severe UC (n=48). The primary endpoint was a composite of endoscopic response and clinical response at Week 6. In this post-hoc analysis, video endoscopies were re-evaluated using the Dova Vision UC tool, an AI-based system designed to assess UC disease activity. Dr Krisztina Gecse (Amsterdam University Medical Centre, the Netherlands) presented the results [1].

In the primary analysis, personalised dosing was not found to be superior to standard dosing,  with response rates of 57% versus 44% (P=0.56). However, the post-hoc AI-based analysis revealed a significant difference between the study arms in favour of the personalised dosing group (78% vs 36%; P=0.0042). “This demonstrates the potential of AI to improve clinical trial methodology fundamentally,” said Dr Gecse. Furthermore, post-hoc endoscopic remission rates were higher in the personalised dosing arm than in the standard dosing arm (52% vs 20%; P=0.033).

In conclusion, personalised infliximab dosing proved superior to standard dosing in patients with acute severe UC when endoscopies were evaluated using AI. “This is the first randomised controlled trial to show differences in study outcomes when endoscopies are read by AI rather than by human experts,” concluded Dr Gecse.

1. Gecse KB, et al. Artificial intelligence endoscopy scoring demonstrates that TDM-based infliximab dose-intensification is superior to standard dosing in patients with acute severe ulcerative colitis: a post-hoc analysis of the TITRATE study. LB10, Hot off the press: IBD treatment, UEG Week, 4-7 October 2025, Berlin, Germany.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 6 October 2025