Medical Therapy of IBD in the First Year After Diagnosis: Preliminary Results from the Ocean State Crohnʼs and Colitis Area Registry (OSCCAR)

Abstract

Purpose: The Ocean State Crohn's and Colitis Area Registry (OSCCAR) is a novel population-based, prospective inception cohort of patients with inflammatory bowel disease (IBD) in Rhode Island. The frequency of medications used to treat IBD during the first year after diagnosis was analyzed with a focus on steroids, immunomodulators and biologics. Methods: Residents of Rhode Island with newly diagnosed Crohn's disease (CD), ulcerative colitis (UC), or indeterminate colitis (IC) were eligible for enrollment beginning January 1, 2008. Diagnosis of IBD was confirmed using criteria from the NIDDK IBD Genetics Consortium. Individuals diagnosed before January 2008, unwilling to provide consent, and those imprisoned or pregnant at diagnosis were excluded. Research assistants collected demographic data, medical history and disease related information, quality of life and disease activity questionnaires, blood, urine and stool samples, with quarterly follow-up in the first year, then every 6 months. 97 of 98 gastroenterologists/colorectal surgeons in RI and 11 in MA agreed to refer patients. Practice billing data were queried and chart reviews were conducted to capture missed referrals. IRB approval was obtained. Results: For enrolled patients, medical therapy during the first year is summarized in tables 1 & 2. 5-ASA was the mainstay of therapy for UC, and a high rate of 5-ASA use was observed in CD. The rate of immunomodulator use was much higher in pediatric compared to adult patients (both CD and UC). CD patients were more likely to be on an immunomodulator or anti-TNF agent compared with UC patients. A substantial percentage of patients were started on anti-TNF therapy early after diagnosis. Conclusion: Among patients captured in this prospective, inception cohort from RI, different patterns of medication usage are seen in adult and pediatric patients, as well as in UC and CD. More than half of patients were exposed to steroids in the first year after diagnosis. A large portion of CD patients were on 5-ASA despite the lack of evidence supporting its use for this indication. Long term follow-up of these patients will yield insight into prescribing patterns and clinical effectiveness of various IBD therapies. Funding:CCFA/CDC 5U01DP000340-03 and NIH 1R21DK078555-02.Table: OSCCAR: medication use in patients with Crohn's diseaseTable: OSCCAR: medication use in patients with ulcerative colitis and indeterminant colitis