Joshua Berkowitz, MD1, Noah Becher, DO1, Samip Shah, MD1, Arun Swaminath, MD2, Keith Sultan, MD1
1Northwell Health System, Manhasset, NY; 2Lenox Hill Hospital, New York, NY
Introduction: A treat-to-target (TT) strategy, setting mucosal healing (MH) in inflammatory bowel diseases (IBD) as the desired treatment endpoint, is currently favored by experts. Advocates of this approach recommend the intensification of medical therapy to reach the goal of MH, even in patients who are in steroid free clinical remission. The utilization and practice of the TT strategy is unknown.
Methods: A retrospective chart review was performed for all IBD patients in the Northwell Health system to identify those in clinical remission who underwent colonoscopy between 01/01/2016 and 12/31/2018. Clinical remission at the time of colonoscopy was defined by a stable, steroid free IBD drug regimen and no IBD related surgery or hospitalization for 6 months prior. Patients in clinical remission but without MH reported on colonoscopy were defined as TT candidates. Demographic and treatment data were extracted from the medical record. We examined the frequency and type of TT utilization, defined as escalation of medical therapy within 1 month of the index colonoscopy. Analysis of variables associated with TT utilization was performed using the chi-square test.
Results: 960 patients had a colonoscopy by 34 different gastroenterologists during the study period. 382 patients met criteria for clinical remission, 248 of whom had gross disease activity classifying them as TT candidates, Table 1. None of the 134 patients with MH had a change in their medication regimen within 1 month of colonoscopy. Among TT candidates 42 (16.93%) had utilization of TT during the 1 month follow-up. Patients utilizing TT were more likely to have no baseline medication use, 39.5% vs. 20.87 (P= 0.0102). There was decreased utilization of TT among those patients already using immunologic and/or biologic therapies, 21.42% vs. 38.88% (p=0.03), Table 2. Patients utilizing vs. not utilizing TT where similar by age, gender, IBD type, and CD surgical history. For patients utilizing TT, strategies included initiation or modification of biologic therapy more commonly among CD vs. UC/indeterminate colitis patients, 64.29% vs. 10.71% (P=0.0005). TT utilizing 5-ASA was more common for UC/indeterminate colitis vs. CD, 82.14% vs. 35.71% (P=0.003), Table 3.
Discussion: We have demonstrated a low rate of TT utilization in our study population. When used, a TT strategy favoring biologic therapy was more common in CD. Further validation of TT, along with physician and patient education, will likely be needed if TT is to become widely adopted.
Citation: Joshua Berkowitz, MD; Noah Becher, DO; Samip Shah, MD; Arun Swaminath, MD; Keith Sultan, MD. P1364 - UTILIZATION ANALYSIS OF A TREAT TO TARGET APPROACH FOR INFLAMMATORY BOWEL DISEASE: A MULTI-CENTER HEALTH CARE SYSTEM REVIEW. Program No. P1364. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.