P0228 Evolution of the IBD-Disability Index in a cohort of recently diagnosed CD patients: results from the prospective CROCO (Crohn´s Disease Cohort) Study
Authors: Buisson A , Bonnet-Dodel- M , Revés J , Burisch J , Madsen G R , Arebi N , Fadra A , Vieujean S , Monin L , Cravo M , Duricova D , Ellul P , Kaimakliotis I , Sebastian S , Ordas I , Rodríguez-Lago I , Mocanu I , Hernandez V , Nachury M , Fumery M , Goldis A , Pedersen N , Conceição D , Barberio B , Guedes A , Ribeiro R , Ungaro R , Mary J Y , Bigot N , Jérome Lambert J L , Colombel J F , Torres J ,   CROCO Study Group
Published: January 2025

Abstract

Background
Crohn’s disease (CD) often results in progressive bowel damage and disability. Disability has been proposed as an endpoint for disease-modification trials by the SPIRIT-IOIBD1 consensus, though data on the evolution of the IBD-Disability Index (IBD-DI) over time remain limited.

Methods
The Crohn’s Disease Cohort (CROCO) is a prospective, ongoing study of newly diagnosed CD patients (within 12 months of diagnosis), assessing changes in bowel damage and disability. Disability was measured using the validated IBD-Disability Index (IBD-DI), which includes 14 questions scoring from 0-100 across domains of health, sleep and energy, emotional well-being, body image, pain, defecation, interpersonal activities, and work/education. The IBD-DI was categorized as no disability (0-20), mild disability (21-35), moderate disability (36-50) and severe disability (51-100). We examined changes in the IBD-DI from baseline to the second year of follow-up.

Results
Among 394 patients recruited, 105 had complete IBD-DI data at incluision and at 24 months. The cohort was 54% male, with a median age at diagnosis of 35.5 years (IQR 24.9-47.9). Median time from symptom onset to diagnosis was 6.1 months (IQR 2-20), with a disease duration of 8.2 months (IQR 4.6-10.3) at study entry. Table 1 summarizes disability categories at baseline, year 1, and year 2. Between baseline and year 2, disability decreased in 30% of patients, remained stable in 48%, and increased in 23% (Figure 1). Changes in IBD-DI were significantly associated with gender (p=0.004) and symptoms (Harvey-Bradshaw index) at baseline (p=0.002), but not with extra-intestinal manifestations (EIM), therapies, or surgical history. Among patients with bowel resection within the 1st year of diagnosis, IBD-DI decreased in 50%, remained unchanged in 43%, and increased in only 7% between baseline and year 2 (p= 0.15). Starting an advanced therapy within the 1st year after diagnosis did not impact IBD-DI evolution between baseline and year 2 (p= 0.92).

Conclusion
Our findings show the evolution of disability in newly diagnosed CD patients highlighting that IBD-DI is able to change in more than half of the patients within the first two years after diagnosis. While disability improved in almost 1/3 of patients, 1/4 of patients still experience moderate-to-severe disability after 24 months.

References
1 Le Berre, C., Peyrin-Biroulet, L., Sandborn, W. J., Colombel, J. F., Rubin, D., Chowers, Y., ... & Danese, S. (2021). Selecting end points for disease-modification trials in inflammatory bowel disease: the SPIRIT consensus from the IOIBD. Gastroenterology, 160(5), 1452-1460.