P0237 Opportunity for action in Spanish IBD patients with Sub-optimal Disease Control: Subanalysis of IBD-PODCAST Study
Authors: Gómez E , Rubio S , Suárez P , Vera M I , Paredes J M , Hernández-Camba A , Plaza R , Mañosa M , Pajares R , Sicilia B , Madero L , Vega P , Huguet J M , Santos de Lamadrid R , Michelena N , García M , Gomollón Garcia F 
Published: January 2025

Abstract

Background
Timely, effective management of inflammatory bowel diseases (IBD) is crucial to achieve sustained clinical remission, and prevent bowel damage and disease progression and complications, as demonstrated by the PROFILE trial and reinforced by ECCO guidelines on therapeutics of Crohn’s disease (CD)1. Endoscopic activity and consecutive elevated fecal calprotectin values are predictive of worse IBD outcomes2,3.

Methods
The IBD-PODCAST was a non-interventional, cross-sectional, multicounty study, including 396 patients from 14 Spanish hospitals, recruited from February to June 20224. The objective was to determine the percentage of CD and ulcerative colitis (UC) patients with sub-optimal disease control (SDC) in a real-world setting, according to STRIDE-II criteria refined by experts. SDC in 53% of CD and 41% of UC Spanish patients was previously reported4. The aim of this analysis was to evaluate the proportion of these patients with sustained abnormal parameters, and the treatment pattern in patients with SDC.

Results
A total of 104 CD and 83 UC patients with SDC were analyzed. Data on sustained abnormal parameters over 12 months is summarized in Table 1. Among CD patients reporting abdominal pain, 23% experienced this symptom for a duration exceeding 12 months; and 7% of UC patients experiencing rectal bleeding reported this symptom over 12 months. Positively, sustained use of prednisolone at ≥10 mg/day was not reported for longer than 12 months. However, percentages of sustained abnormal parameters were higher for outcomes related to intermediate and long-term targets from STRIDE II. Fecal calprotectin remained above 250 μg/g for more than 12 months in 35% of CD and 26% of UC patients with elevated levels. Endoscopic findings were maintained over 12 months in 29% of CD patients and 18% of UC patients with any endoscopic finding.
Additionally, clinicians reported sustained SDC for 18% of CD patients, and 30% UC patients among the overall group with clinician-reported SDC. Over 35% of IBD patients with self-assessed SDC reported this condition for longer than 12 months.
Remarkably, more than 70% of patients with SDC were either naïve to targeted immunomodulators (TIMs) or were treated with them as first-line therapy (Figure 1), indicating scope for further management.

Conclusion
Although the cohort of Spanish patients with SDC had limited exposure to TIMs, up to one third of patients presented sustained abnormal parameters for over 12 months. These results highlight the opportunity for early intervention with effective treatment in IBD, considering the advancements in therapeutic options in the last three years.

References
1.Gordon H, Minozzi S, Kopylov U, et al. ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. J Crohns Colitis 2024: jjae091.
2.Kim KO. Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice. Clin Endosc 2022;55(4):480-488.
3.Pathirana WPNGW, Paul Chubb SA, Gillet MJ, Vasikaran SD. Faecal calprotectin. Clin Biochem Rev 2018;39(3):77-90.
4.Vega P, Huguet JM, Gómez E, et al. IBD-PODCAST Spain: A Close Look at Current Daily Clinical Practice in IBD Management. Dig Dis Sci 2024;69(3):749-765.