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P790 Epidemiology, clinical characteristics, evolution and treatments in newly diagnosed inflammatory bowel disease (IBD): results from the nationwide EpidemIBD study of GETECCU

M. Chaparro*1, M. Barreiro-de Acosta2, J. Benítez3, J. Cabriada4, M. Casanova1, D. Ceballos5, M. Esteve6, H. Fernández7, D. Ginard8, F. Gomollón9, R. Lorente10, P. Nos11, S. Riestra12, M. Rivero13, P. Robledo14, C. Rodríguez15, B. Sicilia16, E. Torrella17, A. Garre1, F. Rodríguez-Artalejo18, E. García-Esquinas18, J. Gisbert1, EpidemIBD group1

1Hospital Universitario de La Princesa, ISS-IP, Universidad Autónoma de Madrid and CIBEREHD, Gastroenterology Unit, Madrid, Spain, 2Hospital Universitario Clínico de Santiago, Gastroenterology Unit, Santiago de Compostela, Spain, 3Hospital Universitario Reina Sofía and IMIBIC, Gastroenterology Unit, Córdoba, Spain, 4Hospital Universitario de Galdakao, Gastroenterology Unit, Galdakao, Spain, 5Hospital Universitario de Gran Canaria Doctor Negrín, Gastroenterology Unit, Las Palmas de Gran Canaria, Spain, 6Mutua Terrasa, Gastroenterology Unit, Tarrasa, Spain, 7Hospital San Pedro, Gastroenterology Unit, Logroño, Spain, 8Hospital Universitario Son Espases, Gastroenterology Unit, Palma de Mallorca, Spain, 9Hospital Lozano Blesa, IIS Aragón and CIBERehd, Gastroenterology Unit, Zaragoza, Spain, 10Hospital General Universitario de Ciudad Real, Gastroenterology Unit, Ciudad Real, Spain, 11Hospital Universitario y Politécnico de La Fe and CIBEREHD, Gastroenterology Unit, Valencia, Spain, 12Hospital Universitario Central de Asturias, Gastroenterology Unit, Oviedo, Spain, 13Hospital Universitario Marqués de Valdecilla, Gastroenterology Unit, Santander, Spain, 14Hospital San Pedro de Alcántara, Gastroenterology Unit, Cáceres, Spain, 15Complejo Hospitalario de Navarra, Gastroenterology Unit, Pamplona, Spain, 16Hospital Universitario de Burgos, Gastroenterology Unit, Burgos, Spain, 17Hospital General Universitario Morales Meseguer, Gastroenterology Unit, Murcia, Spain, 18Universidad Autónoma de Madrid/IdiPaz and CIBERESP, Department of Preventive Medicine and Public Health, Madrid, Spain

Background

Updated data on the incidence, evolution and treatment strategies used in IBD management in South Europe is needed. This is the largest study on the recent epidemiology of IBD in Spain. The aims of this study were (i) to assess the incidence of IBD in Spain; (ii) to describe the main epidemiological and clinical characteristics of patients at diagnosis and the evolution of the disease; and (iii) to explore the use of treatments in the biological era.

Methods

Prospective and population-based nationwide registry. Adult patients diagnosed with IBD Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)- during 2017 in the 17 Spanish regions were included and will be followed-up for 5 years after diagnosis. Treatment was grouped into 5 categories: mesalazine (oral or topical), steroids (intravenous, oral or topical), immunomodulators (thiopurines, methotrexate or cyclosporine), biologics (anti-TNF, vedolizumab or ustekinumab) and surgery. Cumulative incidence of exposure to each of the studied treatments was estimated by Kaplan–Meier curves.

Results

In total, 3627 incident cases of IBD diagnosed during 2017 from 111 centres covering over 23 millions of adult inhabitants (about 50% of the Spanish population) comprise the study cohort. The overall incidence (per 100000 person-years) of IBD was 14.3: 6.5 for CD, 7.1 for UC, and 0.7 for IBD-U (Figure 1).

Figure 1. Incidence of inflammatory bowel disease (A), Crohn’s disease (B) and ulcerative colitis (C) by Autonomous Communities in Spain in 2017 (cases/100000 person-years). Characteristics of the study cohort and by major categories (CD and UC) are summarised in Table 1.

During a median follow-up of 10 months, 33 (2.4%) CD patients progressed to a more severe phenotype, and 2 (0.01%) UC patients to more extensive involvement. The cumulative incidences of the different treatments are shown in Figure 2.

Figure 2. Cumulative incidence of exposure to treatments in Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBD-U) during follow-up.

Conclusion

The incidence of IBD in Spain is relatively high and similar to figures reported in Northern Europe. IBD patients require the use of substantial diagnostic and therapeutic resources, which are higher in CD than in CU. One third of patients are hospitalised in the first year after diagnosis and over 5% undergo surgery. Our results highlight the high burden of IBD as well as the important challenges faced by healthcare systems to manage this costly and complex disease.