P660 Evaluating the effectiveness of disease assessment at 2 weeks following a course of oral steroids: Does early intervention affect outcomes?
J. Slater, A. ALGIEDER, J. Jones, B. Bates, S. De Silva
The Dudley Group NHS Foundation Trust, Gastroenterology, Dudley, UK
Background
Early intervention in those patients not responding to a course of oral steroids following an Acute flare of their IBD is essential for improved outcomes. It enables re-assessment and escalation of treatment in those that are non-responders. We present our data on the effectiveness of an IBD nurse-led telephone follow-up appointment two weeks after commencing a course of oral steroids and its impact on outcomes.
Methods
Data collected prospectively on all patients treated with oral prednisolone between March and November 2019. Partial Mayo score for ulcerative colitis (UC) and clinical assessment of symptoms for Crohn’s disease (CD) patients were used to assess response to treatment at 2 weeks.
Results
57 patients were treated with a Prednisolone reducing regime during the 8 months period. Patient demographics included 27 males and 30 females,19 CD and 38 UC patients with a median age of 48 (range 16–88). Following 2 weeks of treatment, 54% (31) of patients reported an improvement in symptoms-19 UC patients (Partial Mayo 0–4) and 12 CD patients. However, 45% (26) patients did not have a clinical improvement at week 2, 19 UC (Partial Mayo 2–9) and 7 CD were still symptomatic. In those patients who had not responded 3 were commenced on Azathioprine, 6 on Methotrexate and one patient had a slow response to steroids. Seven patients were escalated to receive biological therapy (3 vedolizumab, 2 infliximab, 1 ustekinumab and 1 adalimumab). Two other patients had their dose of vedolizumab increased, one patient was switched to another class of biologics. Three patients had a Flexible Sigmoidoscopy and following that 2 were admitted to receive IV steroids and escalated to biological therapy and Methotrexate. One patient was directly admitted for biological therapy, and 2 patients had an alternative diagnosis of Bile Salt Malabsorption which was treated. At the 3 months follow-up period all patients were well and had avoided further admissions or surgery, with only one patient electively opting for surgery.
Conclusion
Our data show that following a course of oral steroids for a flare of IBD, 45% are still symptomatic after 2 weeks. In this cohort, optimisation of treatment occurred in 23 patients (88%) with either the introduction of biological agents, or early introduction of immunomodulatory therapy. We believe that These data supports the implementation of an early review with appropriate intervention, demonstrating improved patient outcomes.