P445 Is objective disease monitoring strategy tailored to the presence of clinical symptoms, a prospective cohort study from a tertiary IBD center from Hungary
Lontai, L.(1);Gonczi, L.(1);Komlodi, N.(1);Balogh, F.(1);Barkai, L.(1);Ilias, A.(1);LakatosPhD, P.L.(1,2);
(1)Semmelweis University, Department of Medicine and Oncology, Budapest, Hungary;(2)Mcgill University Health Center, IBD Centre, Montréal, Canada;
Emerging data suggest that a treat-to-target approach and early therapeutic intervention using regular objective disease assessment leads to improved outcomes. Our aim was to evaluate the value of objective disease monitoring during regular follow-up.
Patients presenting in our IBD center between January and December in 2018 were included and followed up for 1 year. Data from clinical visits, clinical disease activity using Crohn’s Disease Activity Index and partial Mayo Score, biomarkers (CBC, CRP, FCAL), stool culture, colonoscopy/sigmoidoscopy, CT/MRI scans, abdominal US, total number of visits, hospitalization or surgery rates, and change in medical therapy were collected. We compared monitoring strategy according to the clinical disease activity in the given quarter-year period based on the patient’s status of clinical disease activity (remission/ flare / post-flare/ continuous activity).
N=161 patients were included (CD:118/UC:43; male: 56%), with predominantly moderate-to-severe disease phenotype (70% on biological therapy). In total, n=644 quarter year periods (n= 554 with patient visit) were evaluated (remission 57%; continuous activity 19%; post-flare 11%; flare 13%). CBC and CRP were performed in 82.9% and 83.9% of all patients with at least one clinical visit in a quarter-year period, regardless of clinical activity in IBD. Colonoscopy was performed in patients with flare or continuous disease activity in 21.1% and 18.9%, but 10.1% of the patients in clinical remission also underwent colonoscopy in a given quarter-year period. In a sub-analysis of UC patients, 24.1% of the patients presenting with disease flare had colonoscopy in a given period. Stool culture and C.difficile stool tests were performed in 17.2% of UC patients with flare. CT scans were performed at a low rate of 2.4% in CD patients with disease flare, while MRI scans were similar in all subgroups of CD patients (7.7-16.7%). 13.2% of patients with cont. activity and 24.5% of patients with flare needed initiation or dose optimization of corticosteroids, while biological start or dose optimization was needed in 31.1% and 33.8% in a given quarter-year period. Mean number of follow-up visits per quarter-year period was high(1.6) even for patients in remission, and 2.4 in flare.
Our study confirmed the use of regular objective biomarker monitoring, independent of clinical activity. We report high utilization of c-scope/sigmoidoscopy as well as MRI (in CD) in the objective evaluation of patients with clinical symptoms or even as part of routine monitoring. CT was reserved for emergency situations, while the use of US was relatively low. Objective monitoring resulted in frequent and early optimization of the therapeutic strategy.