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P344. Therapeutic escalation in patients with ulcerative colitis: systematic analysis of the prevalence and risk factors in the Swiss IBD cohort

E. Safroneeva1, S. Vavricka2, N. Fournier3, A. Straumann4, A. Schoepfer5, 1University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 2University Hospital Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 3University of Lausanne, Institute of Social and Preventive Medicine, Lausanne, Switzerland, 4University Hospital Basel, Gastroenterology and Hepatology, Switzerland, 5University Hospital Lausanne / CHUV, Gastroenterology and Hepatology, Lausanne, Switzerland

Background

To date, studies that systematically assess therapeutic escalation in patients with ulcerative colitis (UC) are scarce. We aimed to assess the percentage of UC patients undergoing therapeutic escalation over time and to identify escalation-associated risk factors.

Methods

Data from the Swiss IBD Cohort Study were analyzed. Eighty percent of patients were recruited in hospitals and 20% in private practices. The percentage of patients undergoing treatment with the following regimens relative to disease duration was assessed: 5-aminosalicylates (5-ASA), steroids, immunomodulators (IM) (azathioprine and 6-mercaptopurine), anti-TNF drugs (infliximab, adalimumab), and calcineurin-inhibitors (cyclosporine, tacrolimus). Patients that were not treated with medical therapy and those that underwent UC-related surgery were also evaluated. Non-parametric data are presented as median and interquartile range.

Results

A total of 901 UC patients were included (females: 45.3%, median age: 41 [32–52] years, median age at diagnosis: 31 [24–40] years, disease duration: 6 [2–14] years). Forty-two percent of patients presented with pancolitis, 42% with left-sided colitis, and 16% with proctitis. The proportions of patients that were either not treated with therapy or else treated with various regimens are as follows: 5-ASA 28.0%, steroids and/or IM 51.0%, anti-TNF and/or calcineurin inhibitors 18.3%, surgery 2.3%, no therapy 0.4% for disease duration of 0 to 2 years; 5-ASA 18.9%, steroids and/or IM 49.5%, anti-TNF and/or calcineurin inhibitors 28.6%, surgery 2.0%, no therapy 1.0% for disease duration of 3–6 years; 5-ASA 16.3%, steroids and/or IM 57.5%, anti-TNF and/or calcineurin inhibitors 20.4%, surgery 5.0%, no therapy 0.8% for disease duration of 7–14 years; 5-ASA 15.0%, steroids and/or IM 60.9%, anti-TNF and/or calcineurin inhibitors 9.7%, surgery 14.0%, no therapy 1.4% for disease ≥15 years. Young age at UC diagnosis (OR 0.955, 95% CI 0.929–0.981, p = 0.001) as well as pancolitis (OR 2.404, 95% CI 1.261–4.584, p = 0.007) were the main risk factors for a rapid therapeutic step-up requiring treatment with anti-TNF drugs and/or calcineurin inhibitors within the first two years after UC diagnosis.

Conclusion

Less than 20% of UC patients were treated solely by 5-ASA after a disease duration of ≥3 years. Young age at disease onset and pancolitis are the major risk factors requiring a rapid step-up within the first two years of disease course.