P238 Symptom burden and indolent disease in newly diagnosed patients with ulcerative colitis and Crohn’s disease - a Copenhagen IBD Inception Cohort Study

Abstract

Abstract Background The early course of ulcerative colitis (UC) and Crohn’s disease (CD) is difficult to predict, particularly regarding identifying patients for whom an indolent course might be expected. Therefore, we aimed to investigate the initial course of UC and CD and clinical predictors hereof in a generalizable population-based inception cohort. Methods We initiated a prospective population-based inception cohort of newly diagnosed patients with UC and CD between May 1st, 2021 and November 1st, 2021, according to the Copenhagen IBD Criteria within the geographical uptake area of Hvidovre University Hospital and Herlev University Hospital. All patients were examined systematically by IBD specialists at diagnosis using endoscopy, magnetic resonance (MR) enterography, and patient-reported measures including Simple Clinical Colitis Index (SCCAI) and Harvey-Bradshaw Index (HBI) for UC and CD, respectively. Indolent disease presentation was defined as the absence of UC or CD-related hospitalization, surgery, or decision to start steroid, immunomodulator, or biologic therapy within three months of follow-up. In addition, well-recognized predictors of long-term disease course of UC and CD were a priori defined and implemented in a univariate logistic model, and factors with a p-value smaller than 0.10 were included in the multivariate model. Results The study included 63 adult patients with UC and 50 with CD. At diagnosis, 23 (36.5%) and 13 (26.0%) patients with UC and CD were in clinical remission according to their SCCAI or HBI score, respectively (Table 1). The symptomatic disease burden is outlined in Table 2–3. Interestingly, well-recognized risk factors for the long-term disease course of UC and CD, including disease extent, behavior, baseline endoscopy, MR enterography, and serologic data, did not predict the initial disease course in a multivariable analysis (Table 4). However, C-reactive protein <10 mg/L were associated with an indolent course of UC (adjusted odds ratio=6.2 (95% confidence interval 1.3–38.9), p=0.03). Conclusion The preliminary data from the ongoing prospective population-based cohort study indicate that very heterogenous disease course patterns might be experienced very early. As initial disease control is considered critical for long-term outcomes, this study highlights the inapplicability of long-term predictors for the short-term disease course. It emphasizes the need for further development of simple clinical tools or biomarkers for early patient stratification.