Early endoscopy linked to fewer complications for patients with IBD

PHILADELPHIA — Early endoscopic assessment following the initiation of biologic therapy was associated with a lower risk for hospitalization, surgery and other complications in patients with inflammatory bowel disease, according to research presented at the American College of Gastroenterology Annual Meeting.

“Emerging data showing that early intervention and achievement of mucosal healing may actually decrease the risk of disease-related complications of IBD,” Berkeley Limketkai, MD, PhD, of the Stanford University School of Medicine, said in his presentation. “The adoption and impact of this treat-to-target approach and its relationship with disease-related complications has yet to be assessed.”

For their study, Limketkai and colleagues sought to evaluate this management approach and determine if early endoscopic assessment reduced IBD-related complications.

Researchers analyzed data from a large, commercial health claims cohort of patients with IBD who initiated biologics between 2007 and 2016. They assessed rates of disease-related complications, including corticosteroid use, emergency department visit, hospitalization and bowel surgery, and compared rates between patients who underwent endoscopy within six months of initiation and patients who did not.

Investigators found that just 12.8% of patients with Crohn’s disease (n = 17,807) and 16.3% of patients with ulcerative colitis (n = 4,543) underwent early endoscopic screening.

Early endoscopy was associated with a reduction in 24-month risk for disease-related complications in CD (adjusted HR = 0.87; P = .02) and UC (aHR = 0.68; P < .01). Patients who underwent early endoscopy were more likely to change biologic (CD: aHR = 1.15; P < .01; UC: aHR = 1.25; P < .01), which was linked to a reduction in complications (CD: aHR = 0.35; P < .01; UC: aHR 0.28; P < .01). Additionally, researchers found that the benefit of early endoscopy was greater within four months of biologic initiation in CD and within six months of initiation for UC.

Limketkai and colleagues wrote that their findings suggest that the benefit of early endoscopy might be related to proactive disease monitoring and early treatment optimization.

“Early endoscopic evaluation after the initiation of biologic therapy reduces the risk of disease-related complications, which is consistent with a treat-to-target approach,” Limketkai said. – by Alex Young

Reference :

Limketkai B, et al. Abstract 50. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Limketkai reports no relevant financial disclosures. Please see the study abstract for all other authors’ relevant financial disclosures.