P509 Surgery and biologic prescription rates for Crohn's disease in Lothian, Scotland; an updated population-based cohort study.
Jenkinson, P.(1)*;Plevris, N.(2);Lyons, M.(2);Gros Alcalde, B.(2);Derikx, L.(2);Constantine-Cooke, N.(3);Arnott, I.(2);Jones, G.(4);Lees, C.(2);
(1)NHS Lothian, Colorectal Surgery, Rosewell, United Kingdom;(2)Western General Hospital, GI Department, Edinburgh, United Kingdom;(3)University of Edinburgh, Institute of genetics and cancer., Edinburgh, United Kingdom;(4)Edinburgh IBD Unit, Edinburgh IBD Unit, Edinburgh, United Kingdom;
Background
Recent years have seen a shift in Crohn’s disease (CD) management to earlier initiation of biologic therapy using a treat to target strategy. We have previously published a population based cohort showing a reduction in CD surgery rates and increase in biologic prescribing over time.
Methods
The aim of this study was to identify trends in rates of surgery and biologic prescription in CD over time in a population-based cohort. All incident CD cases diagnosed between 01/01/2000 and 31/12/2017 were identified from the Lothian IBD registry . Abdominal surgeries and biologic prescription from diagnosis to July 31st 2022 were identified from national coding data and the EHR.. The cohort was divided into quartiles by date of diagnosis: 2000-04, 2005-08, 2009-13 and 2014-17; comparison was performed using the log rank test.
Results
560/1753 (30.3%) incident CD cases underwent resectional surgery over a median of 12 years follow-up (IQR 8-14). The overall cumulative incidence rates of first surgery at 1, 5, and 10 years were 7.41% (95% CI, 3.4%–10.4%), 16.1% (12.2%-19.6%), and 29.9% (25.2%–34.4%), respectively. When comparing temporal trends there was a significant reduction in surgical rates by date of diagnosis (logrank p <0.00) (Fig 1). There was no difference in the rate of repeat surgery between cohorts (p=0.156).
Fig 1. Kaplan–Meier curves for risk of first surgery in Crohn’s disease during follow-up of cohorts defined by year of diagnosis.
A total of 703/1753 patients (34.3%) were prescribed biologics. The rates of first biologic prescription at 1, 5, and 10 years were 8.2% (CI:, 4.4%– 12.3%), 22.2% (18.8%-25.6%), and 34.7% (31.4%–37.8%) respectively. When comparing temporal trends, there was a significant increase in biologic prescription rates by date of diagnosis (logrank p <0.001; Figure 2). Biologic prescription in the first year after diagnosis rose significantly over time from 1.0% in the earliest cohort to 22.2% in the latest.
Fig 2. Kaplan–Meier curves for risk of first biologic in Crohn’s disease during follow-up of cohorts defined by year of diagnosis.
Conclusion
We have identified a significant increase in the cumulative incidence of biologic prescription and use of biologics earlier in the patients IBD journey over time. This has been parallelled by a significant reduction in the incidence of first surgery which has been maintained with longer follow up.