P1227 Predictors of biologics/JAKi use, surgeries, and hospitalisations in a newly diagnosed cohort of IBD patients: Long-term outcomes from the nationwide EpidemIBD study of GETECCU
Authors: Garre A , Núñez Ortiz A , Rubio S , Diz-Lois Palomares M T , Riestra S , Alonso-Galán H , Fernández-Salgado E , Ferreiro-Iglesias R , Vela M , Ponferrada Díaz Á , Sánchez Rodríguez E , Hernández V , Arias García L , Barrio J , Huguet J M , Ginard D , Rivero M , Vera I , Alonso-Abreu I , Benítez J M , Aguas M , Rodríguez-Lago I , Calvet X , Fernández-Salazar L , Echarri A , Arroyo M T , Navarro-Llavat M , Vega P , Sierra M , Guerra del Río E , Vicente R , Casanova M J , Navarro P , Ortiz de Zarate J , Varela Trastoy P , Spicakova K , Gutiérrez A , Martín-Arranz M D , Gisbert J P , Chaparro M 
Published: January 2025

Abstract

Background
Factors influencing the exposure to targeted therapies (biologics/JAKi), intestinal resections and hospitalisations in newly diagnosed IBD patients have been scarcely studied. Aim: To identify predictive factors of exposure to biologics/JAKi, surgeries, and hospitalisations within the first five years in IBD patients.

Methods
Prospective, population-based nationwide registry. Adult patients diagnosed with IBD [Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)] during 2017 in the 17 Spanish regions were included. Patients who consented were followed-up for 5 years after diagnosis. Multivariate analyses were performed to identify the predictive factors for biologics/JAKi use, surgeries, and hospitalisations. To this end, only abdominal surgeries were analysed, and early treatment with immunomodulators or biologics/JAKi drugs were considered if these had been prescribed within the first six months of diagnosis.

Results
A total of 1,526 patients diagnosed with CD and 1,633 with UC were included (figure 1). The cumulative incidence of exposure to biologics/JAKi drugs, surgeries, and hospitalisations were analysed, and predictive factors were identified.
Regarding the predictors of exposure to biologics/JAKi treatments, we observed that younger age, more aggressive phenotype of CD and greater extent of UC were associated with a higher risk of exposure (table 1). Furthermore, smoking was associated with a higher likelihood of exposure to biologics/JAKi drugs in patients with CD (HR=1.33, 95%CI=1.11-1.60) while in UC patients it was associated with a lower risk (HR=0.56, 95%CI=0.35-0.89). Concerning surgeries (table 1), early treatment with immunomodulators was associated with a lower risk in patients with CD (HR=0.33, 95%CI=0.22-0.49), whereas early use of biologics/JAKi drugs was associated with a higher likelihood of surgery in patients with UC (HR=11.86, 95%CI=4.62-30.42). Finally, the exposure to biologics/JAKi drugs was associated with a lower risk of hospital admissions both in patients with CD (HR=0.37, 95%CI=0.24-0.56) and UC (HR=0.45, 95%CI=0.22-0.91) (table 1).

Conclusion
The exposure to biologics/JAKi drugs is mediated by the more aggressive phenotype of CD, greater extent of UC, and younger patient age. The use of biologics/JAKi drugs, as currently practiced, is associated with a lower risk of hospitalisations but does not reduce the need for surgery, even when administered early. There is an unmet need for more accurate identification of patients who require these treatments to modify the natural course of the disease.