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Introduction The Vedolizumab Clinical Decision Support Tool (VDZ-CDST) is a validated tool to predict response to vedolizumab (VDZ) treatment for Crohn’s disease (CD). This tool provides a composite score to stratify patients into high (>19), intermediate (>13 to ≤19), and low (≤13) probability of response. We assessed the real-world utility of the VDZ-CDST across 7 centres in the UK and Hungary.Methods CD patients who completed VDZ intravenous (IV) induction therapy between 2015 and 2024 were included in the study and were stratified based on their VDZ-CDST scores. No imputation was used for missing data points. Clinical response (CRES), corticosteroid-free (CSF) CRES, clinical remission (CREM), and CSF CREM were assessed at the first visit, 6 months, and 12 months post-induction. These outcomes were then evaluated for the combined high/intermediate probability group, defined by a VDZ-CDST score >13, to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Rates of IBD-related hospitalisation, surgery, steroid-sparing, and primary non-response (PNR) were recorded across all CDST strata.Results Of the 231 patients included [95 males; median age 45.8 years; interquartile range (IQR) 29.1], CRES and CREM rates consistently decreased from high to low probability groups across all time points ( table 1). The high-probability group achieved CSF CREM rates of 58%, 70%, and 83% at the first, 6-month, and 12-month visits, respectively; in comparison, the low-probability group reached rates of only 14%, 20%, and 21% at those same time points.Using a cutoff score of >13, the VDZ-CDST demonstrated high sensitivity (90–93%) and PPV (77–80%) for CRES across all three time points, though specificity (18–26%) and NPV (26–55%) were lower. Similarly, for CREM, sensitivity ranged from 93–97%, specificity from 18–28%, PPV from 54–74%, and NPV from 71–80%.Patients in the high-probability CDST stratum had better clinical outcomes than those in the low-probability group, including higher steroid-sparing rates (71% vs 39%), lower PNR (10% vs 36%), and lower IBD-related hospitalisation (12% vs 46%) and surgery rates (4% vs 32%).Conclusion VDZ-CDST, with its high sensitivity and PPV, can be used as an effective clinical tool for identifying patients likely to benefit from VDZ therapy.Abstract P248 Table 1Clinical response and remission rates by VDZ-CDST risk category and timepointTime PointGroupCRESCSF-CRESCREMCSF-CREMFirst visit (median: 3.4 months)High (N=97)87%77%63%58%Intermediate (n=106)69%55%46%38%Low (N=28)64%43%29%14%6-month visitHigh (N=71)87%80%75%70%Intermediate (N=74)70%62%61%58%Low (N=20)45%40%20%20%12-month visitHigh (N=52)90%88%83%83%Intermediate (N=62)71%63%68%63%Low (N=14)57%50%21%21%CRES: clinical response; CREM: clinical remission; CSF: corticosteroid-free