P0836 - Treat-to-Target: A Comparison of Treatment and Patient Outcomes Between Academic and Private Practices in IBD Qorus

Jacqueline J. Chu, MD¹, Andrew Krane, MD¹, Siddharth Singh, MD², Gil Melmed, MD, MS³, Corey A.. Siegel, MD, MS⁴, Arthur H. Ostrov, MD⁵, Ridhima Oberoi, BS⁶, Alandra Weaver, MPH⁶, Sarah Harvey, ⁶, Samir Shah, MD^7
1Brown University / Warren Alpert Medical School, Providence, RI; ²University of California San Diego, La Jolla, CA; ³Center for Inflammatory Bowel Diseases, Cedars-Sinai Medical Center, Los Angeles, CA; ⁴Dartmouth-Hitchcock Medical Center, Lebanon, NH; ⁵Saratoga Schenectady Gastroenterology Associates, Saratoga Springs, NY; ⁶Crohn's and Colitis Foundation, New York, NY; ⁷Gastroenterology Associates, Providence, RI

Introduction: IBD Qorus is a national collaborative of academic (AC) and private practices (PP) sponsored by the Crohns and Colitis Foundation. In IBD, treat-to-target (TTT) approach focuses on mucosal healing for proactive, early treatment optimization tailored to clinical and patient-reported outcome goals correlated with disease remission. Real-world implementation of TTT and its impact on clinical practice can vary. We evaluated differences in treatment approaches and outcomes between AC and PP using a TTT approach in the IBD Qorus group.

Methods: Data was collected retrospectively from November 2020 to October 2022 on patient characteristics, PRO-2 disease severity, medical therapy use, use of steroids or narcotics, and hospitalizations. TTT scores range 0-3 (1 pt each: endoscopic/laboratory evidence of mucosal healing, discussion of steroid-free mucosal healing at visits, and treatment change if mucosal healing was not achieved). Univariate analysis compared patient characteristics, disease severity, and treatment practices between AC and PP. Multivariate analysis measured odds of hospitalization.

Results: 3492 (Crohn’s: 2128, UC: 1364) AC and 5869 (Crohn’s: 3542, UC: 2327) PP patients were included. PP cohort was older (age >60: 30.0% vs. 23.5%, p< 0.001) and greater proportion was in PRO-2 remission (Crohn’s 72.4% vs 67.8%, p< 0.001; UC: 68.6% vs 56.9%, p< 0.001). Smaller proportion of PP patients had other indicators of severe disease (hospitalization, ED visits, steroid use, and opiate use). In multivariate analysis after controlling for disease severity, PP patients (Crohn’s OR 0.54, UC OR 0.57, p< 0.001) had lower odds of hospitalization. Monotherapy and dual therapy patterns varied between PP and AC, with greater rate of dual advanced therapy use in Crohn’s patients in AC (1.5% vs 0.7%, p=0.006) (Table 1). TTT score distribution varied between PP and AC (p< 0.001); greater proportion of PP had TTT score of 2 (49.9% vs 39.5%) and greater proportion of AC had TTT score of 3 (30.8% vs 23.8%).

Discussion: AC had more severe disease but still had higher odds of hospitalization after controlling for disease severity. Appropriately, PP and AC both had low rates of 5-ASA use in CD, and high rates of biologic use in IBD. PP had higher rates of IV biologic use, while AC had higher rates of subcutaneous biologics and dual advanced therapies. Future investigation should elucidate reasons for the differences in medical therapies and TTT approach, and subsequent effects on clinical outcomes.


Disclosures:


Jacqueline J. Chu, MD¹, Andrew Krane, MD¹, Siddharth Singh, MD², Gil Melmed, MD, MS³, Corey A.. Siegel, MD, MS⁴, Arthur H. Ostrov, MD⁵, Ridhima Oberoi, BS⁶, Alandra Weaver, MPH⁶, Sarah Harvey, ⁶, Samir Shah, MD⁷. P0836 - Treat-to-Target: A Comparison of Treatment and Patient Outcomes Between Academic and Private Practices in IBD Qorus, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.