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P692 Therapeutic management of Ulcerative Colitis at gastroenterology units in Spain

I. Marin-Jimenez*1, C. Saro2, V. Díaz3, A. Gutierrez4, N. Borruel5, M. Gómez-García6, M. Barreiro-de Acosta7

1Hospital General Universitario Gregorio Marañón, Digestive Medicine- Gastroenterology section, Madrid, Spain, 2Hospital de Cabueñes, Digestive Department, Gijon, Spain, 3AbbVie Farmacéutica S.L.U., Inmunology, Madrid, Spain, 4Hospital General Universitario, Digestive Medicine Department, Alicante, Spain, 5Hospital Universitario Vall d´Hebrón, Gastroenterology, Barcelona, Spain, 6Hospital Universitario Virgen de las Nieves, Digestive Department, Granada, Spain, 7Hospital Clínico Universitario, Gastroenterology- Inflammatory Bowel Disease Unit, Santiago de Compostela, Spain

Background

Management of ulcerative colitis (UC) disease depends on the severity of disease and other factors. The therapeutic approaches for UC may vary from country to country or even from site to site. We aim to describe the therapeutic management of UC at Gastroenterology Units (GE) in Spain.

Methods

Adult patients with confirmed UC were randomly included in the retrospective, multicentre, cross-sectional EPICURE study. Data concerning current therapeutic management and at UC diagnosis were collected during a single routine follow-up visit. A descriptive analysis of data was done.

Results

A total of 568 UC patients (55% males; median age: 47 years) were recruited in 58 GE units. At study start, 82.8% (470/568) of patients were receiving 5-ASA, 29.9% immunomodulators (IM; azathioprine or mercaptopurine), 13.4% were on biologicals (in combination with IM in 40 of 76 patients) and 7.8% were receiving steroids. Nevertheless, 5.8% of patients were not receiving treatment.

Treatment of patients in remission at study start (n=497) was 5-ASAs (82.9%), IM (27.8%), biologicals (12.5%) and steroids (4.0%); 6.4% of patients in remission were not receiving treatment. Most patients with active UC at study were on 5 ASAs for mild (87.2%), moderate (76.9%) or severe (60.0%) disease. Some patients with mild disease were on IM (43.6%), steroids (20.5%) or biologicals (20.5%). About half percent of patients with moderate disease were on steroids (50.0%) or IM (53.8%). A large proportion of patients with severe disease were on steroids (60.0%) or biologicals (40.0%). A median of 0 (Q1, Q3: 0, 6), 3 (Q1, Q3: 1, 7) and 7 (Q1, Q3: 4, 13) years elapsed from UC diagnosis until starting 5-ASA, IM, and biological therapy, respectively. In case of a relapse, mesalamine was frequently used for mild or moderate flare and steroids for severe flare.

Around 20% (n=133) of patients reported to have some UC treatment related complaint being digestive intolerance (27.4%), leucopenia (17.7%), opportunistic infections (14.2%), bone marrow aplasia (8.9%), hepatotoxicity (7.8%) and pancreatitis (5.3%) the most frequent.

Conclusion

Most UC diagnosed patients are treated with 5ASAs. IM were commonly (~ 50%) used in mild or moderate disease, steroids in moderate or severe disease and biologicals in severe disease. Mesalamine is commonly used for mild or moderate flares and steroids for severe ones.