IBD

50 - Early Endoscopic Evaluation After Initiation of Biologic Therapy Reduces Disease-Related Complications in Inflammatory Bowel Disease, Supporting the Concept of Treat-to-Target

Tuesday, October 9
2:55 PM - 3:05 PM
Location: Terrace Ballroom 2-3 (level 400)

Category: IBD
Berkeley Limketkai, MD, PhD1, Siddharth Singh, MD2, William J. Sandborn, MD, FACG2, Parambir S. Dulai, MD2
1Stanford University School of Medicine, Palo Alto, CA; 2University of California San Diego, La Jolla, CA

Introduction: The STRIDE consensus recommended that inflammatory bowel disease (IBD) patients undergo routine follow-up with lower endoscopy within 6 months of biologic initiation to document endoscopic improvement (treat-to-target). The adoption and impact of this monitoring approach on the subsequent occurrence of disease-related complications are yet to be assessed. The aim of this study was to evaluate whether early endoscopic evaluation after biologic initiation reduced disease-related complications.

Methods: IBD patients who initiated biologics were identified in the Truven MarketScan® (2007-2016), a large commercial health claims database. Kaplan-Meier and Cox models evaluated composite rates of disease-related complications (corticosteroid use, emergency department [ED] visit, hospitalization, and bowel surgery) in patients who did or did not undergo lower endoscopy within 6 months of biologic initiation. We controlled for age, corticosteroid use, ED visits, hospitalizations, bowel surgery, and concomitant medications. Subgroup analyses evaluated the effect of endoscopy timing on the rates of disease-related complications.

Results: Only 12.8% (2,279/17,807) CD patients and 16.3% (757/4,643) UC patients underwent endoscopy within 6 months of biologic initiation. Early endoscopy was associated with a reduction in 24-month risk of disease-related complications in CD (aHR 0.87, P=0.02) and UC (aHR 0.68, P<0.01). Patients who underwent an endoscopy were more likely to change biologic (CD: aHR 1.15, P<0.01; UC: aHR 1.25, P<0.01), and a change in biologic was associated with a reduction in disease-related complications (CD: aHR 0.35, P<0.01; UC: aHR 0.28, P<0.01). The benefit of early endoscopy was greater within 4 months of biologic initiation for CD and within 6 months for UC.

Discussion: Among the 13-16% of IBD patients who underwent early endoscopy after biologic initiation, endoscopy was associated with a lower composite risk of corticosteroid use, ED visit, hospitalization, or surgery. Early endoscopy led to a greater need to change biologic, and the change in biologic was associated with a reduction in disease-related complications. These findings suggest that the benefit of early endoscopy may relate to proactive disease monitoring and early treatment optimization. Further studies are needed to understand the generalizability of these findings, since only a minority of patients underwent follow-up endoscopy, and unmeasured confounders may have impacted the results observed.

Longitudinal rates of disease-related complications among patients with Crohn's disease who did or did not undergo lower endoscopy within 6 months of biologic therapy initiation.
Longitudinal rates of disease-related complications among patients with ulcerative colitis who did or did not undergo lower endoscopy within 6 months of biologic therapy initiation.

Disclosures:
Berkeley Limketkai indicated no relevant financial relationships.
Siddharth Singh indicated no relevant financial relationships.
William Sandborn: I have completed my disclosures under another profile – I have completed my disclosures under another profile.
Parambir Dulai indicated no relevant financial relationships.

Berkeley Limketkai

Stanford University School of Medicine
Palo Alto, California

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50 - Early Endoscopic Evaluation After Initiation of Biologic Therapy Reduces Disease-Related Complications in Inflammatory Bowel Disease, Supporting the Concept of Treat-to-Target



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