P711 Decreased steroid exposure and disease-related hospitalizations in patients with newly diagnosed inflammatory bowel disease in the era of newer biologic agents – A multi-centre experience in Singapore

Abstract

Background The expanding therapeutic armamentarium for inflammatory bowel disease (IBD) has drastically improved the clinical outcomes of patients with both Crohn’s Disease (CD), and Ulcerative Colitis (UC). However, data of clinical outcomes in newly diagnosed IBD in the era of biologics in recent decades remains limited. We aim to compare the clinical outcomes of newly diagnosed IBD patients in Singapore between the era of conventional biologics (originator Anti-TNF) with those diagnosed during the era of newer biologics over a 14-year period. Methods This is a multi-centre retrospective observational cohort study. Baseline demographics and treatment histories were obtained from the registries of two tertiary centres in Singapore. Clinical outcomes such as systemic steroid use, IBD-related hospitalizations and IBD-related surgeries were obtained. Anti-TNF, anti-integrin, anti-IL-12/23 and biosimilars were approved for IBD management in 2006, 2016 and 2018 respectively in Singapore. Patients diagnosed with IBD from 2006 to 2019 were included and further subdivided into two cohorts: Pre-2013 (from 2006 to 2012) and post-2013 (from 2013-2019). Results During the study period, 725 patients [CD: 331 (46%), UC: 394 (54%), pre-2013: 291 (40%), post-2013: 434 (60%)] were newly diagnosed with IBD. 625 (86%), 475 (65%), and 241 (33%) patients were exposed to 5-ASA, immunomodulators, and biologics respectively. Compared to the pre-2013 cohort, patients from the post-2013 cohort had less exposure to 5-ASA [277 (95%) vs 348 (80%), p<0.001], and immunomodulators [219 (75.3%) vs 256 (58.9%), p< 0.001]. In patients who were started on biologics, the overall median time from diagnosis to biologic initiation was 2.8 (1.1 – 6.3) years. 196 (81.3%) patients started on biologics were initiated from 2016 onwards. Median time to biologic initiation was shorter for the post-2013 cohort, compared to the pre-2013 cohort. (1.4 (0.5 – 2.8) vs 6.9 (4.3 – 9.1) years, p<0.001). This was observed in both patients with CD [1.2 (0.3 – 2.4) vs 6.9 (4.7 – 8.6) years, p<0.001] and UC [2.3 (0.9 – 3.4) vs 7.1 (3.8 – 9.2) years, p<0.001]. Steroid exposure and IBD-related hospitalizations were higher in the pre-2013 cohort [(OR 1.7 (95% 1.2 – 2.5, p=0.001) and (OR 1.6 (95% 1.2 – 2.3, p=0.003) respectively], but no difference was found in the number of IBD-related surgeries between both cohorts (OR -0.02 (95% -0.4 – 0.4, p=0.934). Conclusion Paralleled with earlier, and increased initiation of biologic agents, there is significant reduction of steroid exposure and IBD-related hospitalizations in patients newly diagnosed with IBD in the era of newer biologics, despite a reduction in 5-ASA and immunomodulator exposure.