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Poster presentations: Clinical: Therapy and Observation 2020

P591 Therapeutic management in inflammatory bowel disease: Differences in two IBD inception cohorts: 1991–93 and 2010–11 enrolled in the north-west of Spain

M.L. De Castro Parga, V. Hernández, L. Sanroman, J.R. Pineda, M. Figueira, J. Martinez-Cadilla, S. Pereira, J.I. Rodriguez-Prada

University Hospital Complex of Vigo, Department of Gastroenterology, Vigo, Spain

Background

The treatment of IBD has dramatically changed in the last two decades, with the advent of immunosuppressive and biological drugs. The goal of therapy remains to achieve and maintain disease remission, diminishing disease outbreaks as well. Our aim was to show the changes in the therapy management of IBD between 1991 and 2011 at the first disease outbreak and during the first years.

Methods

Retrospective and descriptive study of two inception cohorts of IBD patients aged 15 years or more that were enrolled in the area of Vigo (north-west of Spain) in two European epidemiological studies: EC-IBD performed from 1991 to1993, and EpiCom performed in 2010 and 2011. First disease outbreak includes treatments employed in the first four months from diagnosis of IBD, We review the therapies that were used at 12, 24 and 36 months from These data, and the successive disease flares as well.

Results

Regarding the management of the first outbreak of UC, we found an increase in the use of topical 5-aminosalicylic acid (5-ASA) and a decrease of topical steroids (p = 0.001) in 2010–2011 cohort. Sulfasalazine was only used in 1991–1993 cohort, and immunosuppressive or biological drugs in 2010–2011 (p = 0.004). Neither ciclosporine nor surgical therapy was used in both cohorts. In the first outbreak of CD there was an increase in the utilisation of systemic steroids (p = 0,004) and a reduction in oral 5-ASA (p = 0,02)) in 2010–2011 cohort. The use of immunosuppressive or biological drugs was found only in 2010–2011 (Table 1). At 12, 24 and 36 months after diagnosis of IBD, more patients had received an immunosuppressive drug, or were in a higher therapeutic step in the 2010–2011 cohort, compared with 1991–93 cohort (p = 0,0001) both in CU and CD (Figure 1). There were no differences in the number of disease outbreaks suffered in these periods of time between both cohorts (Figure 2).

Table 1.
First disease outbreak1991–19932010–2011 P
Ulcerative colitisN=65N=88
Topical 5-ASA4.6%67.1%0.0001
Topical steroids49,2%2.4%0.0001
Oral 5-ASA69.2%73.5%
Sulfasalazyne16%00–0004
Systemic steroids35.4%45.6%
Inmunosuppressive012%0.0004
Biological00
Ciclosporine00
Surgery00
Crohn’s diseaseN=35N=83
Topical 5-ASA00
Topical steroids14.39,2
Oral 5-ASA57.133.80.002
Systemic steroids54.380.50.004
Inmunosuppressive048.10.0005
Biological08.4%
Surgery20

Conclusion

The progressive early use of immunosuppressive therapies at the initial outbreak of IBD, and during the first 3 years of disease is clearly demonstrated, although it was not related to a decrease in disease outbreaks.