Clinical response for 12 months or more to the first advanced therapy is associated with a significant decrease in the long-term risk of hospitalisation: A nation-wide analysis of patients from the UK Inflammatory Bowel Disease (IBD) BioResource

Background and Aims: It is unclear if sustained response to first advanced therapy effects the long-term risk of hospitalisation in patients with inflammatory bowel disease (IBD). We have undertaken a retrospective analysis of clinical outcomes using the National Institute for Health and Care Research (NIHR) IBD BioResource database.Methods: We included adult patients (≥18 years) with Crohn’s disease (CD) or ulcerative colitis (UC) who received treatment with at least one advanced therapy. Treatment response was defined as clinical response or remission for 12 months or longer. The outcome was the incidence of IBD-related long-term risk of hospitalisation, defined as admission for IBD-related surgery or disease exacerbation requiring intravenous corticosteroids over the duration of follow-up. Results: A total of 15531 patients (CD:10024, and UC:5507) were included in the analysis. Overall, 82% of CD patients and 75.2% of UC patients experienced treatment response to their first advanced treatment. Treatment response to the first advanced therapy initiated was significantly associated with a lower long-term risk of hospitalisation in both CD (OR 0.826, 95%CI [0.797-0.857]) and UC (OR 0.975, 95%CI [0.954-0.997]). The median (IQR) time (years) for hospitalisation in CD responders was 2 years (1-4), in CD non-responders was 1.17 years (1-3), p<0.0001, while in UC responders was 1.38 years (0.85-3) and UC non-responders was 1 year (0.65-2), p<0.0019. Conclusions: Treatment response to the first advanced treatment initiated is significantly associated with a lower long-term risk of hospitalisation for IBD. Choosing the best therapy the first time may improve long-term outcomes.