Nitin Gupta, MD1, Bruce E. Sands, MD, FACG2, Miguel Regueiro, MD, FACG3, Marla C. Dubinsky, MD2, David T. Rubin, MD, FACG4, John Hanson, MD5, Faten Aberra, MD, MSCE6, Michael Weiss, MD7, Stephanie Watkins, PhD8, Derek R. Gazis, MS8, Millie D. Long, MD, MPH, FACG9
1Atlanta Gastroenterology, Atlanta, GA; 2Icahn School of Medicine at Mount Sinai, New York, NY; 3Cleveland Clinic Foundation, Cleveland, OH; 4Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL; 5Atrium Digestive Health, Charlotte, NC; 6Penn Medicine, Philadelphia, PA; 7Gastro Florida, Tampa, FL; 8TARGET PharmaSolutions, Durham, NC; 9University of North Carolina, Center for Gastrointestinal Biology and Disease, Chapel Hill, NC
Introduction: American College of Gastroenterology (ACG) guidelines for the management of adults with Crohn's disease (CD) in March 2018 state that oral mesalamine, "should not be used...to treat CD". This abstract estimates the prevalence of any use of mesalamine among patients with CD before and after the implementation of the guideline. It also aims to describe current utilization patterns of mesalamine in CD by disease phenotype, location and concomitant use of biologic agents.
Methods: TARGET-IBD is a longitudinal cohort of IBD patients receiving usual care in the US; this abstract includes CD patients enrolled between March 2017 and December 2018. Medication use was captured as any use in the follow up period. Use of mesalamine was stratified into patients who were on mesalamine alone or patients on mesalamine and a biologic. The proportion of patients on mesalamine was estimated in time windows after the policy change to discern penetration into usual practice.
Results: 732 patients from TARGET-IBD who had baseline data prior to the new recommendation were included. Of these, 14% used mesalamine only, 8% used mesalamine plus a biologic and 78% did not use mesalamine. A total of 65% received care in academic centers and the median duration of disease at enrollment was 12 years. The distribution of patient characteristics was similar after the policy change. Six months after the ACG recommendation, 11% of patients used mesalamine only, 7% were on mesalamine plus a biologic and 82% did not use mesalamine. Prevalence of use for the 3 and 6 month time windows were similar. Subsequent therapy changes and additions in patients on mesalamine are shown in figure 1. Location (colon vs ileum) and type of CD (inflammatory vs fistulizing) were statistically significant predictors of the odds of any mesalamine use both before and after the policy change (OR 3.233 (CI 1.725-6.061) and 3.334 (CI 1.931-5.755, respectively)).
Discussion: Mesalamine use remained stable in the TARGET-IBD CD population, despite the release of the ACG guideline. Individuals with colonic, inflammatory disease were more likely to receive mesalamine, as were Medicare recipients. There was little difference between academic and community practice in implementation of the new standards. Given that the guidelines are relatively new, it is important to follow these participants over a longer period and to monitor practice differences and ways to reinforce the practice recommendations to improve quality and cost of care.
Citation: Nitin Gupta, MD; Bruce E. Sands, MD, FACG; Miguel Regueiro, MD, FACG; Marla C. Dubinsky, MD; David T. Rubin, MD, FACG; John Hanson, MD; Faten Aberra, MD, MSCE; Michael Weiss, MD; Stephanie Watkins, PhD; Derek R. Gazis, MS; Millie D. Long, MD, MPH, FACG. P2342 - ORAL MESALAMINE USE IN CROHN'S DISEASE AFTER IMPLEMENTATION OF THE AMERICAN COLLEGE OF GASTROENTEROLOGY GUIDELINES: A TARGET-IBD COHORT STUDY. Program No. P2342. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.