P208 Patient-reported outcomes in biologic and thiopurine treatment of IBD measured as HRQoL and symptoms
S. Jäghult*, D. Andersson
Karolinska Institutet, Danderyd Hospital, Division of Medicine, Department of Clinical Sciences, Stockholm, Sweden
Biological and thiopurine drugs are these days considered to be first line long-term treatment for severe or 5-ASA non-responding cases of IBD. Treatment strategies can be either single or combination therapy. The monitoring of these treatments tend to vary depending on which treatment strategy is chosen. Patients with biological treatment as either mono- or combination therapy tend to be more frequently monitored, but the frequency and extent of monitoring varies between different IBD clinics. At Danderyd Hospital, all IBD patients also have regular yearly follow-ups with an IBD nurse, regardless of disease activity.
The aim of this study was to compare treatment outcomes in terms of patient-reported symptoms (stool frequency, consistency, urgency, blood and abdominal pain) and health-related quality of life (HRQoL) measured with the Short Health Scale (SHS) between patients treated with either thiopurines (azathioprin or mercaptopurin), biologics (infliximab) or a combination of both.
Data was collected from patients with ongoing stable (>3 months) treatment during 2013 using patient files and SWIBREG, a Swedish national quality registry. The study was cross-sectional, and the data was collected by IBD nurses during routine follow-ups.
A total of 79 patients were included, 35 % female, and 60 % had Crohn's disease (CD) vs 40 % with ulcerative colitis (UC). The mean age was 43 years old. The treatment groups were divided in infliximab only (n=20), thiopurines only (n=33) and combination therapy infliximab + thiopurines (n=26).
There were no significant differences in HRQoL or patient reported symptoms between the different treatment groups. When comparing diagnosis groups, the patients with CD reported overall more symptoms, especially more loose stools. Comparison between genders showed that women, regardless of diagnosis and treatment had significantly lower function scores related to their disease and more overall symptoms (SHS), specifically more bowel moments, more urgency and bloody stools, as well as more fecal incontinence.
This study indicates that regardless of treatment, patients with CD and female patients had more symptoms and that the female IBD patients also had lower function scores related to their disease, even during periods of supposed remission. These Results shows the importance of individualized treatment in IBD care, and that regular routine follow-ups with an IBD nurse with registration of self-reported symptoms and quality of life help to identify patient groups with a need for optimized treatment, both to detect early warning signs of flares or increased disease activity, as well as identifying patients with persisting functional symptoms despite aggressive treatment.