S1816 Missing the Mark: Treat-to-Target Gaps in Real-World Ulcerative Colitis Care

Introduction: The treat-to-target approach in ulcerative colitis (UC) emphasizes proactive monitoring and early treatment adjustment to meet primary treatment targets of clinical and endoscopic remission. However, data on real-world application of these strategies remains limited. We evaluated post-treatment monitoring, remission, and treatment patterns during the first year following initiation of advanced therapy (AT) for UC. Methods: We analyzed data from TARGET-IBD, a longitudinal U.S. registry of patients with clinician-diagnosed IBD. TARGET-IBD includes electronic medical records collected before and after enrollment. Adult patients initiating a new AT (anti IL-12/23, anti-integrin, anti-TNF, JAK inhibitors, S1P modulators) between October 2014 and September 2021 were included for follow-up. Objective reassessment was defined as undergoing endoscopy or fecal calprotectin (FC) testing within 12 months. Remission was evaluated at 2–4 and 10–14 months post-initiation (mimicking induction and maintenance windows). Outcomes included endoscopic remission (Mayo endoscopic subscore = 0 or narrative evidence of inactive disease) and corticosteroid-free remission (no systemic corticosteroid use in the 14 days prior to endoscopy), overall and by line of advanced therapy (first-line [1L] AT vs second-line or later [2L+] AT). Treatment persistence and corticosteroid use were also summarized. Results: Among 686 UC patients, 51% underwent objective reassessment within 12 months; FC testing was rare (17%). At initiation of AT, 61% had extensive/pancolitis, 33% had left-sided colitis, and 6% had proctitis. At 2-4 months, 61 patients (9%) underwent endoscopy: 21% achieved endoscopic remission and 20% corticosteroid-free remission. At 10-14 months, 144 patients (20%) underwent endoscopy: 29% achieved endoscopic remission and 26% corticosteroid-free remission. At this time window, remission proportions were higher for patients on 1L AT compared to 2L+ AT. Among patients with endoscopy at 10-14 months, 67% required at least one corticosteroid prescription after initiating AT. At 10-14 months, 37% had switched or discontinued their initial AT. Conclusion: In this national registry cohort of UC patients initiating a new AT, objective monitoring was infrequent, and corticosteroid use was high over the first year. Remission rates were modest, and many patients required treatment changes. These findings underscore real-world gaps in treat-to-target implementation and early care optimization.