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P569 A national, retrospective, observational study on the use of 5-aminosalicylates (5-ASA) in Crohn’s disease (CD)

A. Hart1, S. C. Ng2, S. Ghosh3, J. Watkins4,5, J. Fullarton6, K. Paridaens*7

1St Mark's Hospital, Harrow, UK, 2The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong, 3University of Birmingham, Birmingham, UK, 4Public Health Wales, Cardiff, UK, 5University of Cardiff, Cardiff, UK, 6Strategen Limited, Basingstoke, UK, 7Ferring International Center, St-Prex, Switzerland

Background

5-ASA is an established first-line therapy for CD, though there are few recent studies on its use in routine clinical practice. The aim of this database investigation was to provide real-world evidence on the use of 5-ASA utilising data from the UK Clinical Practice Research Datalink (CPRD).

Methods

Adult patients (aged ≥18) at the time of first prescription of 5-ASA (index date) with a diagnosis of CD, having been prescribed a 5-ASA at any time between 01 January 2006 and 07 May 2018, were included for analysis. Outcomes included continuation rates, treatment patterns, and resource use.

Results

Of 21456 patients with CD, 9492 (44.2%) had been prescribed 5-ASA, with the majority (5761; 60.7%) starting on oral 5-ASA as monotherapy (Table). Of the total population on 5-ASA, 58.3% (5537) did not require a dose change, 67.6% (6416) did not require supplementary treatment (eg, corticosteroids, immunosuppressants, etc.) during 5-ASA treatment, and 4.6% (436) required a switch to another treatment. Resource use was significantly decreased in the year after 5-ASA initiation compared with the year before 5-ASA initiation (specialist referrals [285 vs. 110], hospitalisations [2475 vs. 1567] and hospitalisation days [19645 vs. 11574]; [all p < 0.001]). Significantly fewer patients required GI surgery during 5-ASA treatment than before treatment (5.3% [501] vs. 7.6% [721]; p < 0.001). In this type of study potential confounding factors, such as evolution or modification of the disease by treatment, are likely to be present and need to be considered. Patients remained on 5-ASA for a mean of 6.4 years (SD 6.1; median 4.7 years, IQR 1.2–10.1) before discontinuation. 77.4% (7347) of patients were still on 5-ASA at year 1, 68.1% (6464) at year 2, 48.5% (4604) at year 5, and 25.5% (2416) at 10 years. Longer retention on 5-ASA was associated with: a shorter time from CD diagnosis to first 5-ASA script (correlation: p < 0.001); use of an oral 5-ASA formulation at initiation (correlation: tablets: p < 0.001; granules: p = 0.008); and dose optimisation (increase: 89.3 months, decrease: 111.4 months vs. 45.5 months for no change; both p < 0.001).

Conclusion

These data indicates that 5-ASA is used as a long-term treatment for CD, as evidenced by continuation rates extending beyond 10 years in a quarter of patients, and this is linked to relatively low levels of hospitalisations, surgery and supplementary treatments requirements. Moreover, patients that started 5-ASA earlier after diagnosis stayed on therapy significantly longer.