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Current paediatric guidelines recommend Infliximab as the first-line anti-TNF therapy for patients with moderate to severe Ulcerative Colitis (UC) 1 and Adalimumab as second-line if there is loss of response.2 3 Some adult studies, however, have shown similar efficacy when comparing both in maintenance treatment.4 5 Due to bed availability, treatment duration, and to reduce disruption to schooling/family life with subcutaneous injections instead of intravenous infusions, our specialised centre’s protocol is to initiate Adalimumab as first-line for most UC patients when clinically appropriate.This audit aims to assess whether it makes a difference to the treatment outcome for patients with UC which anti-TNF medication is started; and on which treatment the patient remained until adult transition (or up until data was collected); the rationale for starting Infliximab as opposed to Adalimumab; why the medication switch was initiated, and review both the Adalimumab induction and maintenance doses.We conducted a retrospective audit in our specialised centre for newly diagnosed UC patients from 1/1/2019 to 31/12/2023. We analysed the data of 186 children (107 males:79 females; aged 3 months to 17 years, Mean 11.64 y, Median 12 y), of which 87 were started on Anti-TNF treatment (64 Adalimumab vs 23 Infliximab) (figure 1).Abstract OC33 Figure 1Representation of initial treatment groups and subsequent outcomesThe data showed the two Anti-TNF groups lead to similar percentages of patients remaining on the same first-line treatment (Adalimumab 56.3% vs Infliximab 56.5%) with statistically not significant difference in comparison of proportion (difference 0.2%, 95% CI -22.6% to 21.8%, p=0.9868) as well as relative risk (RR=1.00, 95% CI 0.58 to 1.73, p=0.9820) and odds ratio (OR=1.01, 95% CI 0.38 to 2.64, p=0.9820).Moreover the difference in comparison of proportion was not statistically significant when the patients switched to the other Anti-TNF (p=0.4129), to other biologics (p= 0.6165) or had surgery (p=0.7706).The analysis also demonstrated the main reasons to start on Infliximab instead of Adalimumab (N=23) were symptomatic patients with high faecal calprotectin (FC) (65.2%) or acutely admitted patients (34.8%).The data demonstrated that patients were mainly switched from Adalimumab to other treatments (N=28) due to non-response (35.7%), loss of response (25.0%) or relapse (21.4%).Furthermore, 85.7% of patients who started on Adalimumab were given the loading doses as per guidelines1, and the ones who remained on this Anti-TNF had a 55.6% vs 44.4% split between weekly and 2-weekly injections.In conclusion, using Adalimumab as first-line Anti-TNF treatment for paediatric UC patients appears to yield similar outcomes to Infliximab. Given these findings, weighing cost-effectiveness and the benefits to the patients our specialised centre has continued with its current protocol, and other specialised centres may consider similar practice. However further studies are needed to determine whether these outcomes are driven by intrinsic biological factors or logistical treatment variables.References Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of paediatric ulcerative colitis, part 1: ambulatory care—an evidence-based guideline from European crohn’s and colitis organization and European society of paediatric gastroenterology, hepatology and nutrition. JPGN. 2018;67:257–291.Vahabnezhad E, Rabizadeh S, Dubinsky MC. A 10-year, single tertiary care center experience on the durability of infliximab in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2014;20:606–13. 194.Volonaki E, Mutalib M, Kiparissi F, et al. Adalimumab as a second-line biological therapy in children with refractory ulcerative colitis. Eur J Gastroenterol Hepatol. 2015;27:1425–8.Thorlund K, Druyts E, Mills EJ, et al. Adalimumab versus infliximab for the treatment of moderate to severe ulcerative colitis in adult patients naive to anti-TNF therapy: an indirect treatment comparison meta-analysis. J Crohns Colitis. 2014;8:571–81. 191.Ananthakrishnan AN, Cagan A, Cai T, et al. Comparative effectiveness of infliximab and adalimumab in Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis. 2016;22:880–5.