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DOP44 Long term outcomes of patients with untreated IBD - A population-based analysis from the epi-IIRN

Magen Rimon, R.(1);Atia, O.(2);Friss, C.(2);Ledderman, N.(3);Greenfeld, S.(4);Kariv, R.(4);Loewenberg Weisband, Y.(5);Gabay, C.(5);Shaoul, R.(1);Odes, S.(6);Matz, E.(7);Dotan, I.(8);Turner, D.(2)

(1)Rambam Medical Center, Pediatric Gastroenterology & Nutrition institute, Haifa, Israel;(2)Shaare Zedek Medical Center, Institute of Pediatric Gastroenterology Hepatology and Nutrition, Jerusalem, Israel;(3)Meuhedet Health Services, Meuhedet Health Services, Tel Aviv, Israel;(4)Maccabi Health Services, Maccabi Health Services, Tel Aviv, Israel;(5)Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel;(6)Ben-Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel;(7)Leumit Health Services, Leumit Health Services, Tel Aviv, Israel;(8)Rabin Medical Center, Division of Gastroenterology, Petah Tikva, Israel

Background

Therapy in IBD is recommended in order to treat or prevent complications. In this nationwide study we aimed to assess the incidence of patients with IBD who were not receiving maintenance treatment after diagnosis and the duration of non-treatment.

Methods

This study was performed on data from four Health Maintenance Organizations (HMOs), covering 98% of the Israeli population. We included all patients with IBD diagnosed from 2005 to 2019. Non-treatment was defined as lack of drug prescription of maintenance medication for at least six months from diagnosis. Sustainability was defined as lack of maintenance medications and without IBD-related surgeries. Cox regression model was used to explore estimated predictors of sustainability.

Results

A total of 30,168 patients were diagnosed with IBD in Israel since 2005 (16,936 [56%] Crohn's disease [CD] and 13,231 [44%] ulcerative colitis [UC]). A total of 5,448 (32%) patients with CD were untreated, compared to 5,158 (39%) with UC (OR 1.35 [95%CI 1.3-1.4]; p<0.001). Non-treatment was more likely in adult compared to pediatric-onset (34% vs 21%, respectively, p<0.001 in CD; and 41%% vs 22%, respectively, in UC; p<0.001) (Figure 1). Sustainability rate in CD was 72%, 46%, 36% and 28% after one, two, five and ten years from diagnosis, while in UC the corresponding rates were 59%, 39%, 24% and 16%. In CD, sustainability was associated with older age at diagnosis (HR 0.996 [95%CI 0.994-0.998]) and no induction therapy (HR 0.7 [95%CI 0.6-0.9] compared to steroids). In UC, sustainability was associated only with female sex (HR 0.9 [95%CI 0.88-0.98]).

Figure 1: time to failure

Conclusion

Most patients with IBD eventually require maintenance therapy. Lack of maintenance treatment is more common in UC. Nevertheless, a third of patients with CD and one quarter with UC who had no medical treatment at six months from diagnosis remained untreated for five years, especially in older patients with CD and those who did not require induction therapy, suggesting milder disease.

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