P1216 Mapping the Ulcerative Colitis patient journey in Saudi Arabia from healthcare professionals' perspective: A cross-sectional non-interventional study
Authors: Azzam N , Mosli M , Almutairdi A , Alghamdi M , Meeralam Y , Alolimi K , Arsalan M , Al-Bawardy B 
Published: January 2025

Abstract

Background
The burden of ulcerative colitis (UC) is increasing in Saudi Arabia (KSA), and patients often suffer from delayed diagnosis and appropriate management 1. This study investigates the current UC patient journey in KSA from healthcare professionals' (HCPs) perspective. It aims to evaluate treatment patterns, identify critical gaps, and provide insights to guide interventions that enhance the quality of life for UC patients in KSA.

Methods
Quantitative interviews were conducted with 60 HCPs (45 gastroenterologists and 15 internists) from different regions in KSA using a computer-assisted personal interview (CAPI) system. The survey domains included clinical symptoms, diagnostic testing, endoscopic scoring, treatment goals, and medications sequencing. Data integrity was guaranteed using pre-programmed data checks and a pilot phase for tool validation. We used the Dimensions software 6.0.1 to analyse descriptive statistics. The protocol was approved by the Institutional Review Board (IRB) (NSOT-2023-09-4) of King Saud University.

Results
Data was collected from 60 HCPs with an average of 17 ± 12.5 years of experience. Most HCPs (60%) use the Modified Mayo Score to categorise UC patients clinically. First-ranked treatment goals were clinical remission (53.3%), endoscopic remission (35%), and quality of life improvement (33.3%). Patients’ lack of awareness and fear of long-term side effects are the main barriers against achieving these goals. For outpatient moderate-to-severe UC, the most common first-line treatments are steroids (34%), (5-ASAs) 5-aminosalicylates (26%), and TNF-α inhibitors (21%). While for second-line treatments, TNF-α inhibitors (23%), interleukin 12/23 inhibitors (19%), and JAK inhibitors (14%) are prevailing. On the other hand, for inpatient acute severe UC, steroids remain the top choice (46%); however, TNF-α inhibitors (28%) surpassed 5-ASAs (12%). Top second-line treatments are the same as moderate-to-severe UC. Sphingosine 1-phosphate (S1P) receptor modulators are not well-utilized since they aren’t SFDA-approved yet. HCPs attribute this to lack of availability (88%), unfamiliarity with the treatment (24%), and formulary exclusion (12%).

Conclusion
This study underscores the complexities of UC management. While HCPs prioritize clinical and endoscopic remission, patient-related barriers such as lack of awareness impede optimal care. First-line treatments for moderate-to-severe UC include steroids, 5-aminosalicylates, and TNF-α inhibitors, while second-line therapies involve TNF-α inhibitors, interleukin 12/23 inhibitors, and JAK inhibitors. However, limited awareness of newer therapies like S1P modulators suggests a need for broader education and improved access to integrate emerging therapies effectively.

References
Mosli M, Almudaiheem H, Alameel T, et al. Saudi Arabia consensus guidance for the diagnosis and management of adults with inflammatory bowel disease. Saudi Journal of Gastroenterology. 2023;29(7):1-35. doi:10.4103/sjg.sjg_277_22