P2672 - Characteristics and Outcomes of Patients Hospitalized With Severe Ulcerative Colitis: A Large Population-Based Cohort Study in the United States

James Lewis, MD, MSCE¹, Yiyu Chen, ², Carrie Huisingh, PhD, MPH², Gareth Parkes, MD, PhD³, Tim Raine, MD, PhD⁴, Lani Wegrzyn, ^2
1Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; ²AbbVie, North Chicago, IL; ³Barts and the London School of Medicine and Dentistry, Royal London Hospital, Barts Health NHS Trust, London, England, United Kingdom; ⁴Cambridge University Hospitals, Cambridge, England, United Kingdom

Introduction: Severe ulcerative colitis (UC) hospitalizations, including those with acute severe UC, result in colectomy and substantial life changes for up to 20% of patients. As the treatment landscape evolves, more knowledge on patient characteristics, treatment use, and outcomes in real-life settings is needed to understand the burden of severe UC hospitalizations.

Methods: We conducted a large retrospective cohort study using electronic health record (EHR) data from integrated delivery networks in the U.S. with linked insurance claims. As a proxy for ASUC, patients hospitalized for UC (primary position) and requiring intravenous (IV) steroid use (N=9,716) from Jan 1, 2014 – Dec 31, 2022 were included. Eligible patients were ≥18 years and had >180 days of prior EHR activity. A nested cohort (n=4,383) of patients discharged from the hospital without undergoing colectomy who had >1 year of post-hospitalization EHR activity and >1 health encounter with a gastroenterologist >1 year after the hospitalization were used to describe treatments and procedures during follow-up. Results were stratified by patient subgroups: 1) no prior IBD, 2) prior IBD, no prior advanced therapy, and 3) prior IBD with prior advanced therapy.

Results: Of the 9,716 patients, the mean age was 46.3 years, 52.7% were female, most had previously diagnosed IBD (83.3%), and 23.8% had prior advanced therapy use. During the hospitalization, 13.5% of patients received advanced therapy, predominately TNFi (11.3%), in addition to IV steroids. Prior to discharge, colectomy was performed in 12.2% overall and in 12.6%, 9.2%, and 19.6% in subgroups 1,2, and 3, respectively (p< 0.0001). Of those discharged without colectomy, 33.3% of patients received advanced therapy within 90 days and 38.4% experienced a UC-related hospitalization within 365 days after the hospitalization. Cumulative risk of colectomy within 1 year after hospitalization was 20.2% in patients overall and 18.5%, 16.1%, and 32.7% in subgroups 1, 2, and 3, respectively.

Discussion: Within a large cohort of patients with severe UC, colectomy occurred in ~20% of patients within 1 year of the hospitalization, ~33% in those with IBD advanced therapy use prior to admission. Despite this substantial morbidity, only 13% utilized advanced therapy in addition to IV steroids during the hospitalization and 33% within 90 days after the hospitalization. Results from this study highlight the need for effective therapies and strategies during and after hospitalization.


Disclosures:


James Lewis, MD, MSCE¹, Yiyu Chen, ², Carrie Huisingh, PhD, MPH², Gareth Parkes, MD, PhD³, Tim Raine, MD, PhD⁴, Lani Wegrzyn, ². P2672 - Characteristics and Outcomes of Patients Hospitalized With Severe Ulcerative Colitis: A Large Population-Based Cohort Study in the United States, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.