P539 Does a change in therapeutic approach modify outcome in IBD patients? A comparison between two cohorts 2004–2007 and 2010–2013
Viola A.*1, Ferracane C.2, Costantino G.1, Alibrandi A.3, Inserra G.2, Fries W.1
1University of Messina, Dept. of Clinical and Experimental Medicine, Messina, Italy 2University of Catania, Dip. di Scienze Mediche e Pediatriche, UO Medicina Interna, Catania, Italy 3University of Messina, Department of Economical, Financial, Social, Environmental, Statistical and Territorial Sciences, Messina, Italy
With the introduction of biologics in the past 15 years, therapeutic approach to IBD has been modified, not only in terms of available medications but also in terms of therapeutic goals.
The aim of the present study was to assess if the newly introduced therapeutic and strategic changes have led to measurable outcome differences.
we retrospectively assessed in two cohorts of patients (cohort 1: 2004–2007, cohort 2: 2010–2013) followed since diagnosis for at least 3 years at the IBD-unit Messina, the therapeutic approach (i.e. use of immunomodulators (IMM) and biologics (BIO)) and outcomes (i.e. steroid-free remission at 1 to 3 years, surgeries, and hospitalizations). Time to IMM or BIO therapy was assessed by Kaplan-Meyer analysis
Sixty-nine patients were identified in cohort 1 (UC: 41 patients, CD: 28 patients) and 77 patients in cohort 2 (UC: 39, CD: 38). Mean age was for cohort 1: 35±14 years, cohort 2: 37±17 years: There was a significant increase of an earlier use of biologics in cohort 2 (p<0.001) together with a slight, but significant (p<0.01), lesser use of IMM.
A a significant (p<0.009) reduction of surgery in CD patients registered in cohort 2 compared with cohort 1 (60.7 vs 39.3%) with the main indication for stenosing behaviour; overall rates in surgery in UC reached 6% without differences between the two cohorts. Steroid-free remission was achieved in 71%, 69%, and 20%, respectively in year 1, 2, and 3 of follow-up in cohort 1 and in 73%, 47%, and 53% in cohort 2. There was a significant difference (p<0.02) in the 3rd year in favour of cohort 2. An early use of BIO represented a significant predictor for steroid-free remission only at year 2 of follow-up (p<0.049, OR 0.53, CI 95% 0.281–0.999), but not at year 1 or 3, whereas IMM was not associated with steroid-free remission in any year. Hospitalisation rates did not differ between the two cohorts (17% vs 25%)
despite a significant change in therapeutic approach, only modest outcome differences were observed. Most importantly, differences were noted for the surgical approach in CD and a lower steroid use in the third year after diagnosis in all IBD patients in the third year after diagnosis. Our result suggest that the anticipated use of biologics alone does not make an important difference but therapy needs still to be optimized.