Rate Of Corticosteroid Use Research Articles

P0456 Peripheral blood eosinophilia: A novel predictor of disease severity in Inflammatory Bowel Disease - A single-center retrospective study

Abstract Background Identifying early predictors of disease severity in inflammatory bowel diseases (IBD) remains crucial for optimizing therapeutic strategies. We investigated whether peripheral blood eosinophilia (PBE) at diagnosis could predict long-term outcomes in adult IBD patients. Methods We conducted a retrospective analysis of 128 IBD patients (78 Crohn’s disease [CD], 50 ulcerative colitis [UC]) diagnosed between 2003 and 2021, comparing them with 49 non-IBD controls. PBE was defined as an eosinophil count exceeding 0.5 × 109/L. We defined severe disease course as meeting any of these criteria: corticosteroid dependency, requirement for multiple biologic therapies (≥2 different classes), or surgical intervention. Disease location, behavior, and severity were classified according to Montreal classification. Outcomes were analyzed using Cox proportional hazard models. Results PBE was detected in 17 IBD patients (13.3%) compared to 2 controls (4.1%, p<0.001). UC patients showed higher PBE prevalence with 8 cases (16%) versus 9 CD patients (11.5%). Regarding disease location in CD patients with PBE, 5 patients (55.5%) had ileocolonic involvement, 3 (33.3%) had isolated ileal disease, and 1 (11.1%) had isolated colonic disease. In UC patients with PBE, 6 (75%) had extensive colitis. During the follow-up period (median 5.2 years), PBE-positive patients demonstrated significantly worse outcomes: 14 out of 17 (82.3%) developed severe disease course compared to 45 out of 111 (40.5%) PBE-negative patients. PBE-positive patients required more frequent hospitalizations (71% vs 35%), had higher rates of corticosteroid use (88% vs 45%), and increased need for biological therapy (76% vs 38%). Notably, 65% of PBE-positive patients developed corticosteroid dependency compared to 30% in the PBE-negative group. Multivariate analysis confirmed PBE as an independent predictor of severe disease course (HR = 1.49, 95% CI: 1.38-1.62, p<0.001). Conclusion This study establishes PBE as a valuable prognostic marker for IBD severity. The presence of eosinophilia at diagnosis strongly correlates with a more aggressive disease course, suggesting the need for early therapeutic optimization in these patients. These findings not only provide a simple and accessible prognostic tool but also highlight eosinophils as a potential therapeutic target in IBD management. Further prospective studies are warranted to validate these findings and explore eosinophil-targeted therapies.

P0938 Corticosteroid and opiate use in Inflammatory Bowel Disease, 25 years after the Crohn’s Therapy, Resource, Evaluation, and Assessment Tool (TREAT) registry was established

Abstract Background Despite data from the TREAT registry, corticosteroids and opiates are still commonly used in inflammatory bowel disease (IBD). During an IBD flare, corticosteroids are a common first line option and opiates are often prescribed for associated abdominal pain. Longer term use of both agents increases the risk of complications, adverse IBD outcomes and can impair quality of life. We sought to understand the size of the “problem” by examining the current real-world prescribing practices for people with IBD across Australia and New Zealand. Methods Crohn’s Colitis Care (CCCare) is a cloud-based electronic medical record used in Australasia. Data feed into a deidentified clinical quality registry (CQR), which was interrogated in September 2024. People with IBD under active care (encounter within 14 months) were included. Results Of 7506 eligible people, 73.1% resided in Australia (n=5487) and 26.9% (n=2019) in New Zealand. There was an even gender distribution with 49.0% (n=3679) male, 48.0% (n=3606) female, and 2.9% (n=221) with gender not documented. The median age was 42 years (IQR 31 – 56) and median disease duration was 10.7 years (IQR 5.1 – 19.2). In the preceding year, 8.6% (n=645) of the cohort were prescribed a course of oral steroids, of whom 61.1% (n=394) were also prescribed an advanced therapy (biologic or novel small molecule). The most common reasons for discontinuing steroids were “course completed” (26.4%, n=112), “inadequate efficacy” (20.75%, n=88), and “rationalisation and/or deep remission” (12.0%, n=51). There was no difference in the rate of steroid use between IBD subtypes (7.9% in Crohn’s disease (CD) vs 9.4% in Ulcerative Colitis (UC) vs 10.4% in IBD-Unclassified (IBDU), p = 0.06). Opiates were prescribed in 7.6% (n=567) of the cohort. However, opiates were only for an IBD indication in 184 people (2.5% of the cohort), with others receiving opiates for non-IBD indications. People with CD were more likely to have been prescribed an opiate than those with IBDU and UC (p < 0.001). Conclusion These are the first data on corticosteroid and opiate use in IBD across Australia and New Zealand. Steroid use in ambulatory care is low and most use appears to be as a bridge to maintaining disease control with other therapy. Globally, reported rates of corticosteroid use have ranged from 13-57%, however much of the data has been explored over longer time periods in comparison to our study. Opiate use within our Australian and New Zealand cohort is comparable to international IBD cohorts. While steroids are predominately used for IBD, opiate use appears to be related to other co-morbidities. These comorbidities are of interest to examine to identify further opportunities to optimise care.

High disease activity influences the presence of vertebral fractures in rheumatoid arthritis.

It is important to assess the risk of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA), as RA is associated with a high risk of VFs. However, the epidemiology and risk of VFs in patients with RA remain inconclusive. The present study therefore clarified the prevalence and associated factors of VFs in patients with RA. We included 107 patients (19 men and 88 women) and retrospectively investigated the number and location of VFs, bone mineral density (BMD), RA disease activity score for 28 joints based on C-reactive protein (DAS28-CRP), and history of medication for RA and osteoporosis. Based on the investigated items, we assessed the prevalence of VFs in patients with RA and the association between the clinical parameters of RA patients and VFs. The average age, disease duration, and DAS28-CRP were 67.9 years old, 14.9 years, and 2.2, respectively. We found that the prevalence of VFs in patients with RA was 30.8%, and 84.8% of patients with VFs and 62.2% of those without VFs had been treated for osteoporosis. We further found that the prevalence of VFs in patients with RA with a history of anti-osteoporotic agent use was 37.8%. In univariate analyses, patients with RA with VFs had significantly higher DAS28-CRP values, a higher rate of corticosteroid use, and lower BMD (p = 0.018, p = 0.004, and p < 0.001, respectively) than those without VFs. A multivariable logistic regression analysis and ordinal logistic analysis revealed that the DAS28-CRP and BMD were independent factors associated with the presence (p = 0.042 and p = 0.011, respectively) and number (p = 0.036 and p = 0.048, respectively) of VFs. The prevalence of VFs was relatively high in patients with RA, regardless of the use of anti-osteoporotic agents. A high disease activity score and low BMD are associated with the presence and number of VFs in patients with RA. Based on these findings, to reduce VFs in RA patients, it is important to tightly control the disease activity of RA in addition to osteoporosis treatment.

Measurable Outcomes of an Ophthalmology and Rheumatology Coordinated Care Clinic.

We evaluated the impact of an Ophthalmology/Rheumatology multidisciplinary clinic for patients with anterior uveitis by comparing outcomes between those who received traditional care (TC) versus coordinated care (CC). We conducted a retrospective cohort study of children with anterior uveitis from a pediatric tertiary care center between 2013 and 2022. Standard descriptive statistics were used; survival analyses explored differences in cohort disease activity and biologic disease-modifying antirheumatic drug (DMARD) treatment. Steroid treatment by cohort was compared using generalized estimating equation model with Poisson distribution and log link. Complications were compared using logistic regression. Number of visits in each cohort were assessed using Poisson generalized estimating equation model adjusted for complications. We studied 215 patients with anterior uveitis; 66% were female, 53% had juvenile idiopathic arthritis, and 23% were idiopathic, with a median age at diagnosis of 8 years old (interquartile range 5-12). CC was associated with a 60% higher hazard of reaching disease control (hazard ratio 1.6; P < 0.01) when controlling for time since diagnosis and anterior chamber cell counts at the beginning of disease activity. CC was associated with starting biologic DMARDs earlier than TC (P < 0.01). Compared with the group who received TC, the group who received CC had a 96% lower rate of glucocorticoid reception per appointment within the first year (P < 0.01). The visit rate was 64% lower for the group who received CC when controlling for total complications per patient. Patients who received multidisciplinary care had better outcomes than patients who received TC. Limitations include different cohort start times and absence of defined criteria for CC referral.

Change in systemic steroid use and surgery rate in patients with inflammatory bowel disease: a Japanese real-world database analysis

BackgroundCorticosteroids are recommended only for induction of remission in inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). This study aimed to evaluate the change in pharmacologic treatment use, particularly systemic corticosteroids, over approximately 30 years, and the impact of biologics on IBD treatment since their appearance in the 2000s.MethodsThis retrospective study conducted in Japan used data from the Phoenix cohort database (January 1990 to March 2021). Patients with disease onset at age ≥ 10 years who received treatment for UC or CD between January 1990 and March 2021 were included. Outcome measures were change in IBD treatments used, total cumulative corticosteroid doses, initial corticosteroid dose, duration of corticosteroid treatment, and surgery rate.ResultsA total of 1066 and 579 patients with UC and CD, respectively, were included. In UC, the rate of corticosteroid use as initial treatment was relatively stable regardless of the year of disease onset; however, in CD, its rate decreased in patients who had disease onset after 2006 (before 2006: 14.3–27.8% vs. after 2006: 6.6–10.5%). Compared with patients with disease onset before biologics became available, cumulative corticosteroid doses in both UC and CD, and the surgery rate in CD only, were lower in those with disease onset after biologics became available.ConclusionsSince biologics became available, corticosteroid use appears to have decreased, with more appropriate use. Furthermore, use of biologics may reduce surgery rates, particularly in patients with CD. UMIN Clinical Trials Registry; UMIN000035384.

Trends in the Use of Corticosteroids in the Management of Acute Spinal Cord Injury in North American Clinical Trials Network Sites.

Immunomodulatory therapeutics represent a potential neuroprotective strategy for the management of acute spinal cord injury (SCI). One of the most intensely debated neuroprotective drugs has been methylprednisolone sodium succinate (MPSS), which was investigated initially for its role in mitigating lipid peroxidation. More recently, the anti-inflammatory/immunomodulatory properties of MPSS have been increasingly appreciated. Over the past two decades, several systematic reviews and clinical practice guidelines related to MPSS use in SCI have been published. The goal of this study was to investigate the temporal changes in the use of steroids at North American Clinical Trials Network (NACTN) centers and to correlate these changes with the evolution in published literature and guidelines. Data on patients enrolled from 2008-2018 in the prospective, multi-center NACTN registry, and in whom information related to the use of steroids was available, were analyzed. Patients were stratified based on whether they received steroids or not. The primary outcome was the change in the rate of steroid use per year between 2008 and 2018. Secondary outcomes included cardiac, gastrointestinal and genitourinary (GIGU), pulmonary, and dermatological complications. We identified 608 patients, of whom 171 (28.1%) were given steroids. In 2008 and 2009, the prevailing paradigm across NACTN centers was in favor of steroid administration and as such 70% (n = 56) of patients received steroids in 2008 and 71.9% (n = 46) in 2009. An abrupt practice reversal was observed in 2010, whereby only 19.7% of patients (n = 14) received steroids, a trend that continued over subsequent years. Increasing literature in the 2000s arguing against the use of steroids culminated in the 2013 CNS/AANS practice guidelines for the management of acute SCI. These guidelines recommended against the use of MPSS for the treatment of those with acute SCI. Over the following years (2013-2018), steroids continued to be an uncommonly used therapeutic option in NACTN centers (range 3.9-16.9%). Patients receiving steroids had significantly higher rates of pulmonary complications (87%, n = 147) compared with those not receiving steroids (73%, n = 265; p = 0.0003). Compared with patients receiving steroids, however, those who did not receive steroids had significantly higher rates of cardiac (40%, [n = 146] versus 23%, [n = 39]; p = 0.0001) and gastrointestinal/genitourinary complications (55%, [n = 189], versus 31%, [n = 52]; p < 0.0001). The 2013 AANS/CNS guidelines and preceding literature appeared to have an impact on dramatically lowering the rates of corticosteroid use for acute SCI in NACTN sites after 2009. Of note, this analysis may not reflect the impact of the 2017 AO Spine Clinical Practice guidelines, which suggested the use of methylprednisolone as a valid practice option for acute SCI, especially for cervical injuries. Enhanced patient involvement in the clinical decision-making process and opportunities to personalize SCI management exist in reference to the use of MPSS in acute SCI.

Black and White Patients With Staphylococcus aureus Bacteremia Have Similar Outcomes but Different Risk Factors.

Staphylococcus aureus bacteremia (SAB) disproportionately affects Black patients. The reasons for this disparity are unclear. We evaluated a prospectively ascertained cohort of patients with SAB from 1995 to 2020. Clinical characteristics, bacterial genotypes, and outcome were compared among Black and White patients with SAB. Multivariable logistic regression models were used to determine factors independently associated with the outcomes. Among 3068 patients with SAB, 1107 (36%) were Black. Black patients were younger (median, 56 years vs 63 years; P < .001) and had higher rates of diabetes (47.5% vs 34.5%, P < .001), hemodialysis dependence (40.0% vs 7.3%, P < .001), and human immunodeficiency virus (6.4% vs 0.6%, P < .001). Black patients had higher rates of methicillin-resistant S. aureus (49.3% vs 44.9%, P = .020), including the USA300 hypervirulent clone (11.5% vs 8.4%, P = .007). White patients had higher rates of corticosteroid use (22.4% vs 15.8%, P < .0001) and surgery in the preceding 30 days (28.1% vs 18.7%, P < .001). Although the median Acute Physiology Score (APS) at the time of initial SAB diagnosis was significantly higher in Black patients (median APS, 9; interquartile range [IQR], 5-14 vs median APS, 7; IQR, 4-12; P < .001), race was not associated with 90-day mortality (risk ratio, 1.02; 95% confidence interval, .93-1.12), and rates of metastatic infection were lower among Black patients (37.2% vs 41.3% White, P = .029). Despite differences in Black patients' higher APS on presentation and more risk factors, including a 5 times higher risk of hemodialysis dependence, 90-day mortality among Black and White patients with SAB was similar.

S862 Rates and Outcomes of Histologic Healing in Crohn's Disease

Introduction: Histologic healing (HH) has been associated with favorable outcomes in patients with ulcerative colitis but its clinical significance in Crohn’s disease (CD) remains unclear. We aimed to determine the prevalence, predictors, and outcomes of HH in patients with CD. Methods: This is a single center, retrospective review of CD patients age ≥18 from 1/1/2012-12/1/2021. Patients with and without endoscopic healing (defined as the absence of ulcers or erosions) were included. HH was defined as either normal or chronic inactive/quiescent inflammation on review of pathology reports. The primary outcomes were the prevalence and predictors of HH in both distal ileal and colonic CD. Secondary outcomes included rates of corticosteroid use, CD-related ED visits, surgeries, and hospitalizations analyzed individually and as a composite outcome. Continuous variables were analyzed using an unpaired student’s t-test. Categorical variables were analyzed using a chi-square test. Results: A total of 90 CD patients were included. The median age was 47 years (range 18-85), 52.0% were female, 63.3% had ileocolonic disease, and 72.2% had endoscopic healing. The overall rate of HH was 30.0%. Among patients with endoscopic healing (n=65), 41.5% (n=27) achieved HH. Ileal HH rate was 63.2% and colonic HH rate was 47.6%. There were no significant differences between the HH and non-HH groups in terms of baseline and disease characteristics (Table). The percentage of patients on biologic medications was 70.4% in the HH group vs. 50% in the non-HH group (p=0.1). In the HH group, the rate of corticosteroid initiation was 42.9% vs. 57.1%, (p=0.89) and the rates of ED visits, hospitalizations, and IBD-related surgeries were not significantly different between the two groups (Figure). The composite outcome was noted in 40.7% of patients with HH vs. 59.3% of patients without HH (p=0.91). Conclusion: In this pilot study, 30% of CD patients achieved HH, with a higher rate of ileal compared to colonic HH. Among patients with endoscopic healing, HH was not associated with any further decrease in adverse clinical outcomes. This study is limited by small sample size and potentially sampling error of endoscopic biopsies due to the patchy nature of CD inflammation. Larger studies are needed to identify predictors and significance of HH in CD.Figure 1.: Comparison of outcomes between histologic healing vs. no histologic healing (*Composite outcome is defined by either discontinuation of therapy/dose escalation, steroid use, ED visits and/or hospitalizations related to active CD). Table 1. - Comparison of Characteristics Between Histologic Healing vs. No Histologic Healing Patient characteristics Histologic Healing (n=27) No Histologic Healing (n=38) P-value Baseline characteristics Age (years), mean (SD) 52.6 (16.0) 48.7 (17.8) 0.36 Female sex, n (%) 13 (48.2) 26 (68.4) 0.10 Smoking, n (%) 5 (18.5) 4 (10.5) 0.36 Disease duration (years), median (IQR) 16 (7-21) 11.5 (4-21.8) 0.38 Disease characteristics Prior bowel resection, n (%) 6 (22.2) 9 (23.7) 0.89 Presence of extraintestinal manifestations, n (%) 7 (25.9) 11 (28.9) 0.79 Perianal disease, n (%) 8 (29.6) 11 (28.9) 0.95 Medication factors On biologic, n (%) 19 (70.4) 19 (50.0) 0.10 On immunomodulator, n(%) 6 (22.2) 7 (18.4) 0.71

Investigation of adherence to immunosuppressive therapy and spiritual well-being in liver recipients

ObjectiveIn our study, we investigated the relationship between spiritual well-being and adherence to immunosuppressive therapy after liver transplantation. MethodWe conducted this descriptive and cross-sectional study with the participation of 131 liver transplant recipients after they had received their transplants. Data collection was carried out using a Personal Information Form, the Spiritual Well-Being Scale and the Immunosuppressant Therapy Adherence Scale. The IBM Statistical Package for the Social Sciences 25.0 was used for the statistical analyses. ResultsWhile 73.3% of the patients were at the ages of 45–64, 72.5% were male, and 39.7% had been using immunosuppressive medication for a period between 6 months and 1 year. The rate of corticosteroid use among the patients was 30.5%, and the rate of antimetabolite use was 21.4%. A positive and significant relationship was found between adherence to immunosuppressive treatment and spiritual well-being (B = 0.425, p = 0.017). ConclusionSpiritual well-being is an inexpensive, effective and easy strategy to increase adherence to immunosuppressive treatment. Awareness should be raised in physicians and nurses about the importance of spiritual well-being, and they should be encouraged to support spiritual well-being.

P488 Trends in corticosteroid (CS) use over time and following diagnosis in patients with Inflammatory Bowel Disease (IBD), using IBM® MarketScan®

Abstract Background As part of the IBD-DICE (Determinants, Incidence and Consequences of CS Excess) collaborative research programme, this study examined rates of CS use and excess use in patients with IBD over time and after initial diagnosis. Methods Using IBM® MarketScan®, a representative claims database including details of &amp;gt;200 million individuals annually in the United States (US), we conducted a retrospective analysis of CS use from 2007 to 2018 in adult patients with IBD. Patients with conditions commonly associated with high levels of CS use (other than IBD) were excluded. CS use and excess were examined over calendar time in all patients (prevalent cohort), and in relation to the time of first IBD diagnosis in a newly diagnosed subset (incident cohort). Both a restrictive and a broader definition of CS use were examined. The restrictive definition only included claims for oral budesonide or prednisolone/prednisone with a pre-defined minimum daily equivalent dose of ≥17.5 mg, based on a typical tapering CS prescription for IBD. Under the broader definition, CS use was considered as any claim for oral prednisolone, prednisone, budesonide or methylprednisolone. Excess CS use was defined as either ≥2 CS courses in a 12-month period or ≥3 months of continuous CS use. Results The prevalent cohort (restrictive definition) included a total of 338,837 patients with 1,051,213 observation years. Rates of CS use ranged from 23.7% in 2007 to 19.3% in 2009 and plateaued in subsequent years (18.4%–21.1%). Rates of CS excess were higher from 2007 to 2009 (8.9%–11.5%) than in later years, and remained relatively stable from 2010 to 2018 (7.9%–8.6%). Similar patterns were seen with the broad definition of CS use, with CS excess rates of 15.2% in 2007 and 10.9%–11.8% from 2010 to 2018 (Figure 1). The incident cohort included 106,875 patients with 320,295 observation years. CS use was highest in the first year after diagnosis (24.2% and 29.4% with the restrictive and broad definitions, respectively) and decreased and plateaued by the second year after diagnosis (range: 10.8%–14.8% and 16.8%–21.0%, respectively). Similarly, CS excess was highest in the first year after diagnosis (11.7% and 14.6% with the restrictive and broad definitions, respectively) and decreased and levelled off by the second year after diagnosis (range: 3.6%–6.2% and 5.6%–8.6%, respectively) (Figure 2). Conclusion Despite advances in IBD treatment over the past decade and the adverse effects associated with CS, use of CS has not decreased substantially in the US in recent years. Levels of CS excess remain a concern, and may represent an opportunity for more optimised treatment and education, especially for newly diagnosed patients.

291. Epidemiology of Candidemia Rates during COVID-19 and Comparison of Outcomes in Candidemia Between COVID-19 and Non-COVID-19 Patients

BackgroundFungemia is associated with high rates of morbidity, mortality and increase in length of hospital stay. Several studies have recognized increased rates of candidemia since the COVID-19 pandemic. MethodsA retrospective cohort study was conducted at a tertiary healthcare system in Detroit, Michigan to evaluate the impact of the COVID-19 pandemic on incidence of candidemia. The “pre COVID-19” timeframe was defined as January – May 2019 while the “during COVID-19” timeframe was January – May 2020. To compare incidence and patient characteristics between cohorts, t-tests and chi-square analysis was used. Additional sub-analysis was performed in candidemia patients during COVID-19 timeframe comparing outcomes of patients based on COVID-19 status. A Fisher Exact and Satterthwaite Test were used for analysis of categorical and continuous variables, respectively. ResultsOverall, 46 cases of candidemia were identified in both the pre COVID-19 and during COVID-19 periods. Pre COVID-19, the average number of cases was 3.0 ± 1.2 per month. The incidence more than doubled during COVID-19 to 6.2 ± 4.2 cases per month (p = 0.14) (Figure 1). No significant differences in patient demographics were detected between cohorts, however, patients in the COVID-19 cohort had higher rates of corticosteroid use, mechanical ventilation and vasopressors (Table 1). In the 2020 period, 31 patients developed candidemia and 12 (38.7%) patients tested SARS-CoV-2 positive. On average, COVID-19 patients developed candidemia 12.1 days from admission, compared to 17.8 days in the COVID-19 negative cohort (p = 0.340). Additionally, COVID-19 patients with candidemia coinfection were significantly more likely to expire; 83.3% (n=10) COVID-19 patients expired compared to 36.8 (n=7) in the COVID-19 negative cohort (p = 0.025) (Table 2). Figure 1. Incidence of Candidemia in the Pre-COVID-19 (January 2019 – May 2019) and During COVID-19 (January 2020-May 2020) periods Table 1. Characteristics of Candidemia patients in the pre-COVID (January 2019-May 2019) and during-COVID periods (January 2020-May 2020) Table 2. Characteristics of Candidemia patients in the SARS-COV-2 negative and SARS-COV-2 positive cohorts from January 2020-May 2020 ConclusionThe prevalence of fungemia markedly increased during the COVID-19 surge. Increased use of corticosteroids and broad spectrum antimicrobials, prolonged use of central venous catheters and prolonged ICU length of stay likely contributed to this increase. Patients who developed candidemia co-infection with COVID-19 were found to have poorer outcomes as compared to those who were SARS-CoV-2 negative or untested. Disclosures All Authors: No reported disclosures

Assessment of Treatment in Inflammatory Bowel Disease Patients Using Steroid Assessment Tool (SAT) in a Tertiary Center from Romania

Background and aims: The evolution of inflammatory bowel diseases was significantly improved during the last decade by the new therapeutic options. Classical medications as corticosteroids and 5-aminosalycilates (5-ASA) are still highly used. In order to evaluate the pattern of corticosteroid usage we used a dedicated online tool-the steroid assessment tool. Our purpose was to evaluate if this tool can permit a change in the therapeutic habits and an improvement of quality of care. We succeeded to outline a therapeutic profile for a series of IBD patients in a tertiary centre from Romania. Methods: Two consecutive assessments were made using an online tool named Steroid Assessment Tool (SAT). Corticosteroid pattern of use and all previous and current treatments were registered and analyzed. Also the epidemiological and clinical data were collected and analyzed. The statistical analysis was performed using SPSS® software. Results: Results showed that most of our IBD patients (90%) had been treated with 5-ASA, with 29.2% of CD patients and 54.3% of UC patients currently using 5-ASA. Also, we had more CD patients (78%) than UC patients (56.5%) treated with anti-TNF inhibitors. The rate of thiopurine use was small (2.3%) and of anti-integrin therapy, interleukin 12/23 inhibitors as well. The rate of corticosteroid use was 34% in 2019 and in 2020 it dropped to 25% while the rate of corticosteroid excess was 20.4% in 2019 with a statistically significant decrease in 2020 (p=0,01) when it was 5.95%. Discussion: We managed to draw a therapeutic profile of IBD patients in a tertiary IBD centre from Romania using an online tool named SAT. We noticed that the majority of patients were treated with 5-ASA. Even though 5-ASA are not recommended by recent therapeutic guidelines as treatment for CD, we have 29.2% of CD patients treated with this class of drugs, a rate smaller than other reports but still outside guidelines. In the same time, we have a higher rate of anti-TNF agents use compared to other studies, but a lower rate of thiopurine use. Corticosteroid use was higher the other reports, but we succeeded to lower the rate of corticosteroid use and the rate of corticosteroid excess.Conclusions: The therapeutic profile and habits of prescription in a tertiary IBD centre were analyzed twice using an easy-to-use online tool. The results obtained in our first evaluation led to a change in the therapeutic management, improving our adherence to guideline’s recommendations.

P416 Use of DXA in children with Inflammatory Bowel Disease – a large single centre study

Abstract Background Low bone mineral density (BMD) is a complication in children with Inflammatory Bowel Disease (IBD). Dual-energy X-ray absorptiometry (DXA) is an established screening tool for BMD, yet there are limited data to guide its use in children with IBD. We performed a single site retrospective analysis of the use of DXA and evaluated factors associated with low BMD. Methods Children 3-18 years with IBD diagnosed between 2013-2018 at The Royal Children’s Hospital, Melbourne, Australia, were included. Patient, disease and treatment demographics were collected alongside vitamin D, calcium, CRP, ESR, albumin and faecal calprotectin (FCP) (averaged over 6 months before and after DXA). Rates of corticosteroid use, vitamin D and calcium supplementation, bisphosphonate use and fractures were also collected. Mann-Whitney and Fisher exact tests were used for continuous and categorical group comparison, respectively. Data are presented as median (interquartile range). Results 239 children diagnosed at a median age of 12 (9.1-14.2) were followed for 5.1 (4-6.4) years. 72/239 (30%) children had at least one DXA at 11 (1.25-28.8) months post diagnosis. 28/72 (39%) children had a follow-up DXA 2.3 (1.9-2.9) years post diagnosis. Children referred for DXA had a lower weight centile (48.7 (17.1-78.2) vs 59.7 (31.4-84.7), p=0.03), and were more likely to have Crohn’s disease (OR 2.18, p=0.01). At first DXA, median lumbar spine (LS) Z score was -0.80 (-1.65-0.08), height adjusted LS Z score was -0.65 (-1.18-0.10), hip Z score was -1.30 (-1.80--0.35) and total body less head Z score was -1.40 (-2.55--0.70). 18/72 children had LS Z score &amp;gt; 0. Children with LS Z score &amp;lt; -2.0 (n=14) had lower weight (6.57 (1.78-23.7) vs 51.1 (26.5-68.7), p=0.0002) and height centiles (3.62 (1.17-17.1) vs 42 (16.9-67.1), p&amp;lt;0.0001), higher FCP (3041 (1182-4192) vs 585 (139-2419), p=0.009) (Figure 1), and higher odds of calcium supplementation (OR 16 (95% CI 2.93-89.1), p=0.003) and endocrinology review (OR 9.61 (95% CI 2.65-31.0), p=0.001). No fractures were reported. Of the 28 children with serial DXAs, there was no significant change in Z scores. When comparing children with a worse (16/28) Z score at second DXA to those with improvement (12/28), there was a trend toward lower vitamin D levels (37 (25.2-58.3) vs 62 (46.3-87), p=0.06) at first DEXA, and higher ESR at second DEXA (23.4 (19.3-29) vs 8.20 (3.5-21.9), p=0.02). Conclusion Almost one third of children with IBD at a tertiary referral centre underwent DXA, with lower BMD than age and sex matched controls. Disease activity markers FCP and ESR were associated with lower BMD. There was no significant change in DXA score over time. No fractures were identified over the study period.

Impact of multidisciplinary severe immunotherapy complication service on outcomes for cancer patients receiving immune checkpoint inhibition.

2654 Background: The exponential increase in FDA-approved indications for immune checkpoint inhibitors (ICI) in cancer care has resulted in therapeutic success but also in the occurrence of immune-related adverse effects (irAEs) that can represent a significant clinical challenge. On October 3 2017, the Massachusetts General Hospital (MGH) implemented the Severe Immunotherapy Complications (SIC) Service, a multi-disciplinary care team for patients hospitalized with irAEs. The objectives of this study were to evaluate the impact of SIC Service on 1) healthcare utilization and 2) patients outcomes. Methods: Using pharmacy and hospital admission databases, a list of patients was identified that both received ICI for a malignancy and were hospitalized with severe irAEs in the period prior to initiation of the SIC service and after SIC initiation. The pre-SIC period was defined as an admission between 4/2/2016 through 10/3/2017, and the post-SIC period as an admission from 10/3/2017 through 10/24/2018. The rate of readmission after the index hospitalization was the primary outcome. Secondary outcomes included lengths of stay (LOS) for both initial irAE admissions and readmissions, use of corticosteroids and non-steroidal second-line immunosuppression, ICI discontinuation, and inpatient mortality in the pre- and post-SIC periods. Results: Among 1169 patients treated in the pre-SIC service intervention period; 127 were hospitalized for irAE. Among 1159 patients treated in the post-SIC intervention 122 were hospitalized for irAE. SIC Service implementation was associated with a significant reduction in irAE readmission rates (post-SIC 14.8% vs. pre-SIC 25.9%; odds ratio [OR], 0.46; 95% CI, 0.22-0.95; p=0.036). The length of stay, rates of corticosteroid use, second-line immunosuppression, and ICI discontinuation for irAE, as well as inpatient mortality rates were not significantly different before and after SIC Service implementation. Conclusions: This is the first study to report that establishing a highly subspecialized care team focused on irAEs can be associated with improved clinical outcomes for patients receiving ICI therapy. Such care teams may play an essential part in optimizing irAE care.

Improvement of quality of care in inflammatory bowel disease: the role of Steroid Assessment Tool (SAT)-results from a tertiary center trial

Corticosteroids play an important role in the treatment of inflammatory bowel disease patients. They are used for induction of remission but due to their numerous side-effects they are avoided in the long term treatments.In order to improve medical care for the IBD patients guidelines were developed to avoid steroid excess and to promote regular monitoring of corticosteroid use. The aim of this study was to evaluate corticosteroid treatment using an online tool in a tertiary IBD centre from Romania. Methods: An online monitoring tool – SAT (Steroid Assessment Tool) was used to assess disease characteristics, corticosteroid use, corticosteroid excess as defined by international guidelines and the use of bone protection medication associated to steroid treatment. Two successive evaluations of patients treated in a tertiary IBD center were made, the first one in March 2019 on 44 patients and the second one 12 month later, in March 2020, on 84 patients. Data were statistically analyzed with SPSS® software. Results: The results showed that in 2019 the rate of corticosteroid use was of 34%, while in 2020 there was a decrease of corticosteroid use up to 25%. Regarding steroid excess, in 2019 there were 20.4% of patients treated with steroids in excess, but we managed to reduce it to 5.95% in 2020, a decrease that was statistically significant. Bone protection medication was prescribed to only 6.6% of patients treated with corticosteroids in 2019, but a significant increase up to 95% was obtained in 2020. Discussions: Two SAT evaluations of a tertiary IBD centre from Romania revealed that despite new therapeutic options, the rate of steroid use was higher than that reported in other international studies. The objective evaluation of steroid use determined a change in managing IBD patients, thus we succeeded to decrease significantly the rate of steroid excess and increase the use of calcium and vitamin D associated to corticotherapy. Conclusions: The use of an objective tool for monitoring corticosteroid use determined an improvement in managing IBD patients and thus of quality of care.

Does inflammatory bowel disease have different characteristics according to stage of adolescence?

Background:There is a lack of data about demographic and treatment characteristics of adolescent patients with inflammatory bowel disease (IBD). The aim of this retrospective, epidemiological study was to evaluate characteristics and therapeutic features of Hungarian adolescents with IBD.Methods:We analysed the social security databases of the National Health Insurance Fund. Adolescent patients with IBD for whom data from 2009 to 2016 were observable in the database were enrolled. Patients aged 14 to 17 years and 18 to 21 years were defined as middle and late adolescent patients.Results:The incidences of IBD were 20.12 per 100,000 middle adolescent patients and 29.72 per 100,000 late adolescent patients. Admission to gastroenterology department was higher in both groups compared with admissions to surgery department. Mesalazine was used by a high proportion of Crohn’s disease and ulcerative colitis patients. Rates of corticosteroid use were similar in both groups, with a tendency to decrease over time. The need for biologic agents was higher in the middle adolescent patients. The proportion of patients in the middle adolescent group who received anti-TNF therapy showed an increasing tendency.Conclusion:Our data suggest differences in the treatment strategies of gastroenterologists for these age groups. The greater need of anti-TNF therapy among the middle adolescent group indicates that adolescent patients before the transition to adult care may have a more severe disease phenotype. We expect that a strategy of early, effective treatment will significantly ameliorate the subsequent disease course, which is manifested in adult care.

Impact of Idiopathic Pulmonary Fibrosis on Longitudinal Health-care Utilization in a Community-Based Cohort of Patients

Idiopathic pulmonary fibrosis (IPF) is a rare, chronic lung disease associated with substantial symptom burden, morbidity, and cost. Delivery of high-quality effective care in IPF requires understanding health-care resource utilization (HRU) patterns; however, longitudinal data from real-world populations are limited. This study aimed to define HRU attributable to IPF by evaluating a longitudinal cohort of community patients with IPF compared with matched control subjects. Incident IPF cases were identified in the Kaiser Permanente Northern California electronic health records (2000-2015) using case-validated code-based algorithms. IPF cases were compared with matched control subjects by age, sex, and length of enrollment. Annual rates of HRU measures were assessed during the 5 years pre- and postdiagnosis. Poisson generalized estimating equations were used to estimate adjusted case-control differences in HRU. IPF treatment trends were assessed before and after the availability of IPF-specific medications. A total of 691 IPF cases were identified and matched with 3,452 control subjects. Adjusted rates of all diagnostic procedures were significantly increased (P< .001) for IPF cases compared with control subjects in both the pre- and postindex periods, including chest CT scans (pre-relative risk [RR], 80.35; post-RR, 32.79), 6-min walk tests (pre-RR, 20.81; post-RR, 34.49), and pulmonary function tests (pre-RR, 9.50; post-RR, 13.24). All-cause hospitalizations (pre-RR, 1.42; post-RR, 2.33) and outpatient visits (pre-RR, 1.22; post-RR, 1.80) were significantly higher among cases compared with control subjects during both the preindex (P< .05) and postindex (P< .001) periods. We observed use of immunosuppressive and IPF-specific therapies prior to diagnosis, and high rates of corticosteroid use before and after diagnosis. This study defines a marked increase in HRU in patients with IPF compared with control subjects, with accelerated use beginning at least 1 year prediagnosis and elevated use sustained over the following 5 years. To our knowledge, this is the first study to evaluate longitudinal medication trends in IPF. Collectively, this information is foundational to advancing IPF care delivery models and supporting clinical decision-making.

Rectal eversion: safe and effective way to achieve low transaction in minimally invasive Ileal pouch-anal anastomosis surgery, short- and long-term outcomes.

Ileal pouch-anal anastomosis remains a gold standard in restoring continence in patient with ulcerative colitis. Achieving low transection can be challenging and may require mucosectomy with a hand-sewn anastomosis. Rectal eversion (RE) technique provides a safe and effective alternative for both open and minimally invasive approaches. The purpose of this study is to evaluate short- and long-term outcomes of patients who underwent RE when compared to those who underwent conventional trans-abdominal transection. This is a retrospective review performed at tertiary care center. Patients undergoing proctectomy and pouch surgery by either standard approach or with RE from November 2004 to January 2017 were evaluated. Demographics, post-operative complications, as well as 1- and 3-year functional outcomes were analyzed. Total of 176 underwent proctocolectomy with creation of a J pouch and 88 (50%) had the RE technique utilized. The RE group had a higher rate of corticosteroid use at the time of surgery 59.1 versus 39.8% (p = 0.0156), but otherwise groups were statistically similar. 20 cases (26.1%) of RE group and 54 (61%) of conventional group cases were accomplished in minimally invasive fashion. There was no difference in the rates of 30- and 90-day complications. Functional outcomes data were available for up to 78.4% of patient with trans-abdominal approach and 64.7% in RE group. At 1 and 3 years after surgery, there was no difference in the number of bowel movements, fecal incontinence, or nocturnal bowel movements. The rates of returning to ileostomy or pouch revision were the same. RE technique is safe and effective way to achieve a low transaction in J pouch surgery. The technique provides similar functional outcomes at 1 and 3 years after surgery and can be particularly useful in minimally invasive approaches.

Corticosteroids in management of anaphylaxis; a systematic review of evidence.

As anaphylaxis is a medical emergency, there are no randomized controlled clinical trials on its emergency management. Therefore, current guidelines are mostly based on data from observational studies, animal and laboratory studies. Although epinephrine is the mainstay of recommended treatment, corticosteroids are also frequently used. This review evaluates the evidence on the use of corticosteroids in emergency management of anaphylaxis from published human and animal or laboratories studies. Thirty original research papers were found with 22 human studies and eight animal or laboratory studies. The average rate of corticosteroid use in emergency treatment was 67.99% (range 48% to 100%). Corticosteroids appear to reduce the length of hospital stay, but did not reduce revisits to the emergency department. There was no consensus on whether corticosteroids reduce biphasic anaphylactic reactions. None of the human studies had sufficient data to compare the response to treatment in different treatment groups (i.e. corticosteroids, epinephrine, antihistamines). Animal studies demonstrated that corticosteroids act through multiple mechanisms. These modulate gene expression, with effects becoming evident 4 to 24 hours after administration. A much quicker response has been detected within 5 to 30 minutes, through blockade of signal activation of glucocorticoid receptors independent of their genomic effects. Therefore, we conclude that there is no compelling evidence to support or oppose the use of corticosteroid in emergency treatment of anaphylaxis. However, based on the available data, it appears to be beneficial and there was no evidence of adverse outcomes related to the use of corticosteroids in emergency treatment of anaphylaxis.

Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up

BackgroundEndoscopic mucosal healing is an established treatment target for UC, yet the value of achieving histological remission remains unclear.AimsTo evaluate histological remission compared to endoscopic mucosal healing for predicting patient...