S0724 Characteristics of Crohn's Disease Patients in the Corrona Inflammatory Bowel Disease Registry on Biological or Conventional Therapy Differ by Disease Duration

Abstract

INTRODUCTION: Real-world comparisons of Crohn's Disease (CD) patients on biologic (BIO) vs conventional (CONV) therapy may be confounded by differences in patient characteristics, including duration of disease. This study aimed to characterize CD patients by therapy group and disease duration. METHODS: CD patients in the Corrona Inflammatory Bowel Disease (IBD) Registry from 5/3/17 to 3/3/20 were grouped by therapy at enrollment as BIO or biologic-naïve CONV (5-ASAs or immunosuppressants) and by short disease duration (ShD) <10 years or long duration (LD) ≥10 years. Patient characteristics, including patient-reported outcomes (PROs), were compared using standardized differences (Sdiff), where >0.10 represents a relevant imbalance between groups. RESULTS: Among 774 CD patients in the study, both ShD (n = 372) and LD (n = 402), a higher % of patients on BIO were younger, male, had private insurance (Table 1), history of ER use for IBD, ileal and less colonic disease, and younger age of IBD onset than CONV (Table 2). Compared to CONV-ShD, BIO-ShD had shorter time since CD symptom onset but longer time since CD diagnosis, similar mean Harvey-Bradshaw Index (HBI), % in remission, and current perianal fistula, but more previous perianal fistula, penetrating and stricturing disease, history of IBD surgery, and >1 surgery type (Table 2). BIO-ShD had less fatigue, pain interference, depression, and anxiety (Patient-Reported Outcomes Measurement Information System (PROMIS)), and less absenteeism, presenteeism, and % work and daily activities affected by IBD (Work Productivity Activity Impairment (WPAI)) (Table 3). Compared to CONV-LD, BIO-LD had shorter time since CD symptom onset and diagnosis, similar mean HBI and % in remission, but more stricturing disease, current, and prior perianal fistulas, history of IBD surgery, >1 surgery type, and ER use for IBD (Table 2). BIO-LD had more fatigue, sleep disturbance, pain interference, depression, and anxiety (PROMIS), and more absenteeism, presenteeism, and % work and daily activities affected by IBD (WPAI) (Table 3). CONCLUSION: Despite similar HBI and % in remission, BIO-LD had worse PROs, more structural damage, and prior treatment than CONV-LD. BIO-ShD had better PROs despite similar or worse disease characteristics than CONV-SD. These results suggest that HBI does not capture the full burden of CD, and biologic therapies may be associated with better PROs when started earlier in the disease process before structural damage occurs.Table 1.: Patient demographics and comorbidities, overall and by biologic therapy vs. conventional (biologic naïve) therapy for patients with Crohn's Disease (CD) with disease duration <10 years vs. ≥10 yearsTable 2.: Patient disease and treatment characteristics overall and by biologic therapy vs. conventional (biologic naïve) therapy for patients with Crohn's Disease (CD) with disease duration <10 years vs. ≥10 yearsTable 3.: Patient reported outcomes (PROs) overall and by biologic therapy vs. conventional (biologic naïve) therapy for patients with Crohn's Disease (CD) with disease duration <10 years vs. ≥10 years