P1257 Difficult-to-treat Inflammatory Bowel Disease in Latin American countries: prevalence and clinical characteristics.
Authors: Flores C , Yamamoto J , Fróes R , Lasa J S , Balderramo D , Martinez S B , Baños F J , Iade B , Gomes T , Parra Holguín N N , Andrade Zamora D A , Azevedo F , Saes J , Yaeza Ferreira A , Veitia G 
Published: January 2025

Abstract

Background
Inflammatory Bowel Disease (IBD) prevalence has been increasing in Latin American countries.1,2 An international expert consensus proposed criteria to define difficult-to-treat IBD (D2T-IBD).3 We aimed to evaluate the prevalence and characteristics of D2T-IBD in LatAM.

Methods
Observational study with secondary data from four LatAM registries: Epidemiologic characterization of Inflammatory Bowel Disease in Latin America Multicentric Study with patients from 9 countries, the Brazilian Organization of Crohn's Disease and Colitis registry, and two single-centre registries in Argentina (CEMIC - Centro de Educación Médica y Investigaciones Clínicas "Norberto Quirno", and HPUC - Hospital Privado Universitario de Córdoba). We included adult patients diagnosed with IBD (ulcerative colitis - UC, Crohn’s disease- CD, or unclassified) with at least one prescribed drug. Patients were classified with D2T-IBD if having failed 2+ mechanisms of action of Advanced Drug Therapies (ADTs), chronic antibiotic-refractory pouchitis, postoperative CD recurrence after 2+ intestinal resections, or complex perianal CD.3 Characteristics of D2T and non-D2T patients were compared with Mann-Whitney and chi-square tests (p&lt;0.05).

Results
Of 6314 eligible patients, 55.2% had UC, 43.9% CD, and 0.9% were unclassified. The mean ± standard-deviation disease duration at registry inclusion was 12.5 ±10.8 years, and 56.2% were female – Table 1. Of 5598 patients with information, 742 (13.3%, CI95% [12.4%; 14.2%]) were classified with D2T-IBD. The proportion of D2T-IBD was higher among CD patients (30.2% vs 1.6% of UC patients; p&lt;0.001). Most patients met one criterion only (92.1%). The most frequent were complex perianal disease for D2T-CD (90.6%), and failure to 2+ mechanisms of ADTs for D2T-UC (92.3%).
Compared to non-D2T patients, D2T patients were statistically significantly diagnosed at a younger age (mean: 30 ± 13 years old) and had a longer time until diagnosis (1.7 ± 3.5 years), and IBD duration at registry inclusion (12 ± 9 years) – Table 2. D2T patients also had a statistically higher percentage of male patients (55%), and IBD family history (5.5%). D2T-CD phenotype at diagnosis had more fistulizing/penetrating cases (39%) and with ileocolonic (46.1%) or colonic (29.1%) locations. Extensive colitis was more frequent among D2T-UC (82%).

Conclusion
D2T-IBD was identified in about 13% of treated patients in Latin America, affecting about a third of CD patients. Severe clinical factors were associated with D2T-IBD, including characteristics related to a more severe phenotype and poorer prognostic. Future studies should characterize the burden and unmet needs of D2T-IBD patients.

References
1.Kotze PG, Underwood FE, Damião AOMC, et al. Progression of Inflammatory Bowel Diseases Throughout Latin America and the Caribbean: A Systematic Review. Clin Gastroenterol Hepatol. 2020;18(2):304-312. doi:10.1016/j.cgh.2019.06.030
2.Queiroz NSF, Martins CA, Quaresma AB, Olivera Sendra PA, Ernest-Suarez K, Kotze PG. IBD barriers across the continents: a continent-specific analysis: Latin America. Therap Adv Gastroenterol. 2023;16:17562848231167953. Published 2023 Apr 25. doi:10.1177/17562848231167953
3.Parigi TL, D'Amico F, Abreu MT, et al. Difficult-to-treat inflammatory bowel disease: results from an international consensus meeting. Lancet Gastroenterol Hepatol. 2023;8(9):853-859. doi:10.1016/S2468-1253(23)00154-1