P0278 Healthcare resource utilization by patients with Difficult-to-Treat Inflammatory Bowel Disease in Latin American Countries.
Authors: Froes R , Yamamoto J , Flores C , Balderramo D , Lasa J S , Veitia G , Baños F J , Iade B , Andrade Zamora D A , Parra Holguín N N , Gomes T , Azevedo F , Saes J , Yaeza Ferreira A , Martinez S B 
Published: January 2025

Abstract

Background
Latin America is a geographical region with heterogeneous access to health care and advanced drug therapies (ADTs) required for Inflammatory Bowel Disease (IBD) management, especially for more difficult cases.1,2 We aimed to characterize the use of healthcare resources for IBD management, namely for difficult-to-treat IBD (D2T-IBD), in this region.3

Methods
Observational study with secondary data from four LatAM registries: EPILATAM-IBD (Epidemiologic characterization of Inflammatory Bowel Disease in Latin America: Multicentric Study) with patients from 9 LatAM countries, the GEDIIB – Brazilian Organization of Crohn’s Disease and Colitis national registry, and two single-centre registries in Argentina, in Buenos Aires and Córdoba. This analysis included adult patients diagnosed with ulcerative colitis - UC, Crohn’s disease- CD, or unclassified, and at least one prescribed IBD drug. Patients were classified with D2T-IBD if having failed ≥ 2 mechanisms of action of ADTs, chronic antibiotic-refractory pouchitis, postoperative CD recurrence after ≥ 2 intestinal resections, or complex perianal CD. Characteristics of D2T and non-D2T patients were compared with Mann-Whitney test, and chi-square or Fisher’s exact tests (p&lt;0.05).

Results
Of 6314 eligible patients (55.2% UC, 43.9% CD, and 0.9% unclassified), 5598 had criteria information, and 742 (13.3%) were classified as D2T. The proportion of D2T-IBD was higher among CD patients (30.2% vs 1.6% of UC patients; p&lt;0.001). Patients with D2T-IBD were statistically significantly diagnosed at a younger age than non-D2T patients, had a longer time until diagnosis, and more patients were followed in private healthcare setting – Table 1.
D2T patients had statistically significantly higher incidence and mean number of surgeries (73% vs. 10% of non-D2T patients) and hospitalizations (49% vs. 37%) – Table 1. They also received more drugs since diagnosis (36% received 4+ drugs), namely ADTs (19.5% received 3+ ADTs) – Table 2. Among D2T patients, 64% were prescribed immunomodulators and 83% ADTs since diagnosis. The percentages prescribed 2 or more anti-TNFs (28%) and ADTs other than anti-TNF (anti-integrin: 14%, anti-interleukin: 19%, Janus kinase inhibitors: 4.2%) were also higher among D2T patients.

Conclusion
D2T-IBD was associated with a significantly higher incidence of surgeries and hospitalizations, resulting in a higher burden for healthcare systems. In addition, D2T patients required more ADTs, both in the number of different treatments as well as classes other than anti-TNFs. D2T patients represent a relevant unmet medical need in IBD in the Latin America region.

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