P158. Adherence to national guidelines for therapy of Crohn's disease in Germany
B. Bokemeyer1, U. Helwig2, C. Schmidt3, N. Teich4, R. Halle5, M. Düffelmeyer6, H. Raspe7, A. Prenzler8, T. Mittendorf8, H. Hartmann9, 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; 9Center For Gastroenterology, 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 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. Up to October 2011, about 1000 patients were included by 58 gastroenterology practices and hospitals with IBD-experience. This interim analysis reports the clinical data of 459 CD-patients with early disease. National CD-guidelines in Germany (Z Gastroenterol 2008;46:1094146) are based on a based consensus conference by the German Society of Digestive Diseases (DGVS). Adherence to guidelines in complex CD-disease in Germany recently has been suggested to be a problem with only about 50% of patients receiving an appropriate therapy (Z Gastroenterol 2009; 47: P438). An interim analysis of 304 complex disease CD-patients from the early disease group on the adherence to guidelines (escalation to oral immunosuppressants or TNF-alpha therapy) will be presented.
Methods: The registry aims at including 1500 patients with 5 years of follow-up. Complex disease was defined at inclusion/follow-up if one of the following characteristics was present: steroid-dependend/-refractory disease or greater like 2 bowel resections at inclusion or elevated HBI-score/unfitness for work >14 days/high dose steroid re-induction course on at least two follow-up visits or a second bowel resection at any time during follow-up.
Results: 459 patients in the early-disease group with follow-ups up to 24 months (6 months: 258 patients; 12 months: 162 pts; 18 months: 98 pts; 24 months: 47 pts) were analyzed. The average disease duration was 1.2 years. Clinical characteristics of 304 patients met the definition of complex disease. Use of oral immunosuppressants and/or TNF-alpha therapies were introduced surprisingly fast (baseline, 6, 12, 18 and 24 months) from 54.7% to 72.0%, 84.7%, 84.8%, 88.6% and accordingly, active disease patients (PGA) decreased from 53.5% to 31.7%, 29.6%, 27.5%, and 32.4%, respectively.
Conclusions: Follow-up data of patients with complex early CD demonstrated a significant increase of immunosuppressive and/or TNF-alpha therapy (from 54.7% to 88.6%) during long-term maintenance. Adherence to guidelines by IBD-experienced physicians in this real life setting is much higher than prior investigations showed for Germany.