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Early proactive monitoring varies widely in IBD care
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A treat-to-target approach can help reduce disease-related complications in inflammatory bowel disease, but many patients do not undergo assessment for mucosal inflammation before or after initiating biologics, according to study results.
“Clinical trial data have now demonstrated that escalation of therapy based on clinical symptoms and biomarkers of mucosal inflammation results in improvements in the achievement of [mucosal healing], as compared with symptom-based assessments alone,” Parambir S. Dulai, MD, of the division of gastroenterology and hepatology at the University of California San Diego, and colleagues wrote in Inflammatory Bowel Diseases. “What is lacking, however, is an understanding of current practice patterns for monitoring of mucosal inflammation in the United States and associated outcomes with monitoring approaches.”
Researchers looked to explore this topic by using a Truven Health MarketScan search to find patients with Crohn’s disease or ulcerative colitis who initiated biologic therapy (n = 27,146) and compared 24-month, disease-related complications between groups that underwent monitoring and those that did not.
In their assessment, investigators found that approximately 40% of patients had no assessment of mucosal disease activity within the 6 months before initiating biologic therapy, and almost half had no assessment within 12 months after beginning biologic treatment. Within 24 months of initiation, 56.4% of patients with CD and 67.8% of patients with UC underwent either proactive or reactive monitoring, while 11% of patients with CD and 12.8% of patients with UC underwent endoscopy-based, early proactive monitoring within 6 months of starting a biologic.
Compared with no early monitoring, early proactive monitoring was associated with a reduction in disease-related complications for CD (adjusted HR = 0.9; 95% CI, 0.84–0.96) and UC (aHR = 0.87; 95% CI, 0.78–0.97). The reduction in complications was mostly seen in decreased corticosteroid use in both CD (aHR = 0.83; 95% CI, 0.77–0.9) and UC (aHR = 0.77; 95% CI, 0.69–0.87).
“There was considerable variability across the United States in performing any form of proactive monitoring after biologic initiation,” Dulai and colleagues wrote. “This wide variability has direct implications for population-level outcomes, and consideration will be needed regarding whether documented follow-up assessments of mucosal disease activity after biologic initiation should be considered as quality metrics of high-quality health care delivery for at-risk IBD patients who are escalated to biologic therapy.” – by Alex Young
Disclosures: Dulai reports receiving speaker honoraria from Takeda and grant support from ALPCO, Janssen, Pfizer, Polymedco, Prometheus and Takeda. He also reports being a consulting for AbbVie, Janssen and Takeda. Please see the full study for all other authors’ relevant financial disclosures.
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