POS0810 THERAPEUTIC CHOICES-EFFICACY OF THE INTEGRATIVE MANAGEMENT AND PATIENT-REPORTED OUTCOMES IN PATIENTS WITH IBD-ASSOCIATED SPONDYLARTHRITIS: A 4-YEAR OBSERVATIONAL STUDY (THE SPIB COHORT)
Authors: G. Marchionni, V. Paci, L. Perini, A. Zabotti, A. Agostinelli, I. Cimaroli, R. Sordillo, F. Fiorini, R. DI Zio, E. Bendia, A. Benedetti, D. Benfaremo, M. M. Luchetti, G. Moroncini
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Spondyloarthritis associated with Inflammatory Bowel Diseases (SpA-IBD) are immune-mediated diseases classified in the group of Spondyloarthritis (SpAs) and, concordantly, the association of joint and gut inflammation supports a tailored multidisciplinary approach. <h3>Objectives:</h3> In this study, we describe the distinctive clinical features of a large SpA-IBD patients' cohort and assess the therapeutic strategies used in integrative clinical real-world management, focusing on their effectiveness over a long period of clinical observation. <h3>Methods:</h3> Consecutive patients affected by IBD (Crohn's Disease or Ulcerative Colitis), were screened [1], referred to our Spondyloarthritis Clinic and, if diagnosed as SpA-IBD, enrolled in the SPIB Cohort (<b>SP</b>ondyloarthritis in <b>I</b>nflammatory <b>B</b>owel disease) [2]. The cohort underwent comprehensive gastroenterological and rheumatological assessments at baseline, 3, 6, and every 12 months [2]for 4 years. Extensive clinical data, and rheumatological and gastroenterological disease activity scores, were collected at each evaluation (Table 1), guiding a gastro-rheumatological approach towards an appropriate treatment strategies. <h3>Results:</h3> Since October 2016, 159 consecutive patients (mean age 49.1±13.6 years, 59% females) were diagnosed with SpA-IBD, 89 (56.0%) with axial involvement (axSpA-IBD) and 70 (44.0%) with peripheral involvement (pSpA-IBD). The female gender was significantly more represented in pSpA-IBD than in axSpA-IBD (p&lt;0.032), and the duration of musculoskeletal symptoms was higher in axSpA-IBD than in pSpA-IBD (p&lt;0.004) (Table 1). At baseline, patients reported high disease activity across all domains and relevant impairment in physical functioning and quality of life. Thirty-seven (23.3%) patients were assuming steroids (mean prednisone equivalent dose – PED: 7.81±8.31 mg) and 106 (66.7%) csDMARDs; 60 (37.7%) patients were already treated with b/tsDMARDs: 56/60 (93.3%) TNFi, and 4/60 (6.7%) Vedolizumab. Following the integrated gastro-rheumatological assessment, therapy with b/tsDMARDs was started in 46 patients more (+28.9%), accounting for a total number of 106 patients treated with: TNFi in 96/106 (90.6%), anti-IL-12/23 in 2/106 (1.9%), JAKi in 4/106 (3.8%), and Vedolizumab in 4/106 (3.8%). Therapy with oral steroids and/or csDMARDs was maintained in 27 (17.0%; mean PED 1.23±4.01) and 109 (68.8%) patients, respectively (Figure 1B). From 12 to 24-month follow-up, b/tsDMARDs were prescribed in 74/98 (75.5%) patients as follows: 91.9% TNFi, 2.7% anti-IL-12/23, 2.7% JAKi, 2.7% Vedolizumab, whereas therapy with oral steroids and csDMARDs was maintained in 10 (10.2%; mean PED 0.39±1.36) and 75 (76.5%) patients, respectively (Figure 1B). Subsequently, at the 36-month follow-up, therapy b/tsDMARDs was maintained in a similar percentage of patients (45/56, 80.4%), with an increase of anti-IL-12/23 (8.9%), JAKi (2.2%), and Vedolizumab (4.4%), and this therapeutic trend was substantially maintained until the 48-month follow up (Figure 1B). Therapy with oral corticosteroids and/or csDMARDs was continued, but at a lower dose, in a similar percentage of patients from the 36 to 48-month follow-up (Figure 1B). From baseline to month 48, the integrative gastro-rheumatologic management resulted in a significant improvement in all disease activity scores (except the pMayo score), along with a significant improvement in physical functioning and quality of life (Figure 1A). <h3>Conclusion:</h3> The SPIB Cohort is a representative and large cohort of SpA-IBD patients, characterized by a long-time clinical follow-up through integrated gastro-rheumatologic management. Our study demonstrates that thigh cooperation between rheumatologists and gastroenterologists enables a comprehensive assessment with the development of tailored and effective therapeutic strategies. <h3>REFERENCES:</h3> [1] Benfaremo D al. J Rheumatol 2021;48:179-187. [2] Luchetti MM et al. Eur J Intern Med 2019;64:76-84. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Giulia Marchionni: None declared, Valentino Paci: None declared, Lucia Perini: None declared, Alen Zabotti: None declared, Alice Agostinelli: None declared, Ilaria Cimaroli: None declared, Raffaella Sordillo: None declared, Federico Fiorini: None declared, Raissa Di Zio: None declared, Emanuele Bendia: None declared, Antonio Benedetti: None declared, Devis Benfaremo: None declared, Michele Maria Luchetti AbbVie, Amgen, Eli Lilly, Janssen, Novartis and Pfizer., AbbVie, Janssen, Novartis and Pfizer, Abbvie, Gianluca Moroncini AbbVie, Janssen, Novartis and Pfizer, AbbVie, Janssen and Pfizer.