P552 Assessing adherence to objective disease monitoring and outcomes with adalimumab in a real-world IBD cohort.
Xiao, Y.(1);AL Khoury, A.(2);Golovics, P.(3);Kohen, R.(2);Afif, W.(2);Wild, G.(2);Friedman, G.(4);Galiatsatos, P.(4);Hilzenrat, N.(4);Szilagyi, A.(4);Wyse, J.(4);Cohen, A.(4);Bitton, A.(4);Bessissow, T.(4);Lakatos, P.L.(2);
(1)McGill University, Department of Medicine- Internal Medicine, Montreal H3H1E1, Canada;(2)McGill University, Department of Medicine- Gastroenterology, Montreal H3H1E1, Canada;(3)HDF Medical Center, Division of Gastroenterology, Budapest, Hungary;(4)Jewish General Hospital, Department of Medicine- Gastroenterology, Montreal H3H1E1, Canada
Data suggests that tight objective monitoring may improve clinical outcomes in IBD.
The aim of this study is to assess the adherence to serial tight objective monitoring(clinical and biomarkers) and its effect on clinical outcomes. We retrospectively reviewed the chart of 428 consecutive IBD patients started on adalimumab between January 1,2015–January 1,2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index, partial Mayo score), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) assessments were captured at treatment initiation and at 3, 6, 9, and 12 months. Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method
Clinical evaluation was available in nearly all patients at 3(CD-UC:95-94%), 6(90-83%), 9(86-85%) and 12(96-89%) months. CRP was also available in nearly all patients but testing frequency decreased in CD patients over time. Compliance to serial FCAL testing was low. Clinical remission at one-year was higher in patients adherent to early assessment visit at 3 months (p=0.001 for CD and UC). Adherence to early follow-up resulted in earlier dose optimisation in CD and UC patients (pLogrank=0.026 for UC & p=0.09 for CD). Overall drug sustainability did not differ.
Clinical and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization, improved one-year clinical outcomes but did not change drug sustainability.