P308. Low levels of glucocorticoid use in early Crohn's disease in Germany
B. Bokemeyer1, U. Helwig2, A. Stallmach3, N. Teich4, R. Halle5, M. Düffelmeyer6, H. Raspe7, A. Prenzler8, T. Mittendorf8, D. Hueppe9, S. Nikolaus10, S. Schreiber11
1Gastroenterology Practice Minden, University Hospital of Schleswig-Holstein, Department of General Medicine, Kiel, Minden, Germany; 2Internistische Praxisgemeinschaft Oldenburg, Oldenburg, Germany; 3University of Jena, Gastroenterology Department, Jena, Germany; 4Internistische Gemeinschaftspraxis, Leipzig, Germany; 5Gastroenterologische Gemeinschaftspraxis, Hameln, Germany; 6Iomtech GmbH, Berlin, Germany; 7Medical University of Schleswig-Holstein, Institute of Social Medicine/Campus Luebeck, Lübeck, Germany; 8Leibnitz University Hannover, Center for Health Economics, Hannover, Germany; 9Gastroenterology Practice Herne, Herne, Germany; 10University Hospital of Schleswig-Holstein, Klinik für Allgemeine Innere Medizin, Gastroenterology, Kiel, Germany; 11University Hospital of Schleswig-Holstein, Department of General Internal Medicine, Kiel, Germany
Background: The nationwide Biocrohn Registry (Biological Registry with Crohn's Disease Patients in Germany) of the German Competence-Network IBD is a five-year prospective registry of patients suffering from Crohn's disease (CD) in Germany, with whom anti‑TNF biologics were newly introduced. In order to compare the findings matched cases were also prospectively documented as an additional early-disease group (first diagnosis <3 years) by the same physicians. Up to October 2011, about 1.000 patients were included by 58 different gastroenterology practices and hospitals with IBD-experience. This interim analysis reports the clinical data of 459 CD-patients with early disease.
Methods: Within the framework of this non-interventional prospective online documentation, data on the course of the disease, on psychosocial disease burden, on health economics and on the genetic profile will be examined. The registry aims at including 1.500 patients with 5 years of follow-up (2 visits/year).
Results: 459 patients in the early-disease group were analyzed with follow-up durations up to 24 months (6 months: 258 patients; 12 months: 162 pts; 18 months: 98 pts; 24 months: 47 pts). The average age of the early-disease group was 33 years, and the disease duration was 1.2 years. The following therapies were observed in the “early disease” patients at inclusion and usage was compared to the follow-up at 12 months, respectively: 5‑ASA 37.0% vs. 26.7%, budesonide 26.5% vs. 11.1%, oral immunosuppressants 37.3% vs. 59.3%, anti‑TNF 25.7% vs. 28.9%. At inclusion 53.0% of the patients were clinically in remission (Physicians Global Assessment), after 12 (24) months we found 74.4% (75.6%) to be in remission, respectively. The use of systemic glucocorticoids dropped over time (baseline until 6, 12, 18 and 24 months) from 23.6% to 7.6%, 5.9%, 3.7%, and 2.3%, respectively. At baseline 65.4% pursued an active employment and after 24 months this increased to 80.4%.
Conclusions: In this real life setting follow-up data until 24 months of the early disease group are showing a consistent therapy along current guidelines with only minor usage of systemic glucocorticoids in the maintenance therapy. In contrast, use of oral immunosuppressants (59.3%) and anti‑TNF drugs (28.9%) were increasing in most patients with a significant increase of patients being in remission and in active employment.