S787 Early Biologic or Small Molecule Therapy Initiation After Index Hospitalization for an Ulcerative Colitis Flare Prevents Re-Hospitalization

Abstract

Introduction: Ulcerative colitis (UC) patients hospitalized for acute flares are at an increased risk for re-hospitalization. A recent RAND panel recommended early (within 3 months) biologic or small molecule therapy initiation post-discharge; however, evidence supporting this strategy is limited. We aimed to quantify the impact of early biologic or small molecule therapy initiation post-discharge on the risk of re-hospitalization in UC patients Methods: A retrospective cohort study was conducted using TriNetX, a multi-institutional database of more than 70 million patients in the USA. We included UC patients with no prior exposure to biologics or small molecules, hospitalized for the first time, and started on intravenous steroids. We compared re-hospitalization rates for a UC flare at 1- and 2 years based on the timing of medical therapy initiation in-hospital or post-discharge. 1:1 propensity-score matching was performed for age, gender, race, ethnicity, BMI, baseline Hemoglobin (Hgb), C-reactive protein (CRP), and albumin. Odds ratios (OR) with 95% confidence interval (CI) were calculated Results: A total of 1,203 biologic and small molecule naïve UC patients were hospitalized for an acute flare. Patients were treated with methylprednisolone (74%), with a median CRP of 45.1 and albumin of 3.37 on admission. Re-hospitalization for a flare was observed in 338 (28%) by 3 months and 548 (46%) by 12 months. Inpatient biologic (infliximab) or small molecule (cyclosporine) therapy was used in only 12% of patients, and early post-discharge initiation of a biologic was observed in only 27% of patients. Delayed (between 3-12 months post-discharge) initiation of a biologic or small molecule was associated with a significantly higher risk for re-hospitalization at 1- (OR 1.47, 95% CI 1.01-2.15) and 2 years (OR 1.65, 95% CI 1.14-2.41) post-discharge. No significant differences were observed in re-hospitalization risk among patients starting a biologic or small molecule in-hospital versus within 3 months of discharge (OR 1.15, 95% CI 0.68-1.95). A total of 133 (11%) patients were not started on a biologic or small molecule until > 12 months, and only after they had already been re-hospitalized for a second flare Conclusion: Biologic and small molecule naïve UC patients hospitalized for an acute flare are at a significantly increased risk for re-hospitalization up to 1-year later. Initiation of biologics or small molecules within 3 months of discharge is associated with a reduction in risk for re-hospitalization.