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OP016 Treatment strategy during the first year after diagnosis in patients with inflammatory bowel diseases from the 2011 ECCO-EpiCom inception cohort

Z. Vegh*1, J. Burisch2, E.V. Tsianos3, L. Kupcinskas4, S. Turcan5, F. Magro6, 7, 8, A. Goldis9, V. Hernandez10, S. Bell11, P. Munkholm12, P. Lakatos1

1Semmelweis University, 1st Department of Medicine, Budapest, Hungary, 2Hvidovre University Hospital, Gastrounit, Medical section, Hvidovre, Denmark, 3University of Ioannina, 1st Division of Internal Medicine and Division of Gastroenterology, Faculty of Medicine, Ioannina, Greece, 4Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania, 5State University of Medicine and Pharmacy, Department of Gastroenterology, Chisinau, Moldova, Republic of, 6Hospital de São João, Department of Gastroenterology, Porto, Portugal, 7Oporto Medical School, Department of Pharmacology and Therapeutics, Porto, Portugal, 8University of Porto, 8 MedInUP - Center for Drug Discovery and Innovative Medicines, Porto, Portugal, 9University of Medicine ←Victor Babes→, Clinic of Gastroenterology, Timisoara, Romania, 10Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain, 11St Vincent's Hospital, Department of Gastroenterology, Melbourne, Victoria, Australia, 12Herlev University Hospital, Digestive Disease Center, Medical Section, Copenhagen, Denmark

Background

The ECCO-EpiCom study investigates the differences in the incidence, disease characteristics and therapeutical management of inflammatory bowel diseases (IBD) between Eastern and Western Europe. The aim of this study was to analyze the differences in the therapeutical strategy in the 2011 ECCO-EpiCom inception cohort within the first year after diagnosis.

Methods

Fourteen European (9 Western and 5 Eastern European centers) and one Australian center with 258 CD, 380 UC and 71 IBDU patients (65% from Western, 25% from Eastern Europe, 10% from Australia; female/male: 326/383; mean age at diagnosis: 40.9 years, SD: 17.3 years) participated in the one-year follow-up. Patients' data regarding disease characteristics and medical therapy were registered and entered in the web-based ECCO-EpiCom database every third month during the first 12 months after diagnosis.

Results

Both in CD and UC, a significant difference was found in the probability of highest treatment steps reached within one year after diagnosis between Eastern and Western Europe and Australia (Figure 1. and 2.).

 

ECCOJC jju027 OP016 F0001

“Figure 1. Cumulative probability of the highest treatment steps in CD in Eastern Europe”

 

ECCOJC jju027 OP016 F0002

 

“Figure 2. Cumulative probability of the highest treatment steps in CD in Western Europe/Australia”

Overall, the disease behavior (B2 and B3) was the driver for immunosuppressive (IS) therapy (pLogRank<0.001). In Eastern Europe, total 5ASA use was higher in patients with L1(ileal) and B1(non stricturing-non-penetrating) disease (pLogRank=0.001), and in L3(ileocolonic) location received earlier and more IS (pLogRank=0.037). In Western Europe/Australia significantly more CD patients were treated with biological therapy (p=0.04). Overall, penetrating disease behavior was the driver for biological therapy (pLogRank=0.035). In UC, patients in Western Europe/Australia received more steroids (43% vs. 26%, p=0.03, pLogRank=0.01), however disease extent was not different. In contrast, time to 5ASA, IS, biological therapy and colectomy was not different between Eastern and Western Europe/Australia. Time to 5ASA and steroid treatment was dependent on the extent (pLogRank5ASA=0.007 and pLogRanksteroid< 0.001).

 

 

Conclusion

We found a significant difference in the maximum treatment step in both CD and UC during the first year after the diagnosis between Eastern and Western Europe/Australia, with higher exposure to biologicals and lower exposure to 5ASA in CD patients in Western Europe/Australia, while only steroid exposure was different in UC.