S1745 High Prevalence of Advanced Therapy Use in Patients With Crohn’s Disease in a Large Community and Academic Cohort: A Preliminary Analysis From IBD Qorus

Introduction: Early effective therapy is well recognized to improve clinical outcomes in Crohn’s disease (CD), and underutilization of advanced therapies contributes to suboptimal outcomes. Most cohort studies describe advanced therapy (AT) use for only a minority of patients with CD. We hypothesized AT use may be more prevalent in inflammatory bowel disease (IBD) Qorus, a large multicenter learning health system. Methods: Patient and provider survey responses from IBD Qorus were prospectively collected from November 2020 to May 2025 at 48 academic and community practices during routine clinical visits. We included patient visits with recorded current medication use and IBD classification of CD. We report descriptive statistics and a multivariable logistic regression with variable selection using the backward Wald method to identify factors associated with AT use. Differences in PRO3 between patients using vs not using advanced therapy were assessed with the Mann–Whitney U test. Results: Among 16,515 included patient visits, which were divided evenly between community and academic sites, 79.4% (N = 13,105) reported advanced therapy use, including biologics in 76.4% (N = 12,618), small molecules (i.e. JAK1 inhibitors) in 3.5% (N = 579), and combination (2 or more concurrent) AT in 1.2% (N = 195). Patients 71–80 years old (aOR = 0.52, 95% CI: 0.46–0.59), those taking steroids (aOR = 0.84, 95% CI: 0.71–0.99), and those who perceived a benefit from change in therapy (aOR = 0.64, 95% CI: 0.56–0.73) had significantly lower odds of advanced therapy use. The absence of blood in stool was strongly associated with higher odds of advanced therapy use (aOR = 4.34, 95% CI: 4.09–4.66). The median PRO3 CD score was lower among those using AT vs those not using AT (7.00 vs 9.00; P < 0.001). Conclusion: AT use for CD was reported in 79% of visits in this large cohort of both community and academic sites. To our knowledge, this high prevalence exceeds the use reported in other published cohorts. This finding may be explained by cohort members having a special interest in IBD or the effects of participation in the IBD Qorus collaborative. Further analyses should examine trends in advanced therapy utilization over time and across clinical settings, with a focus on patient outcomes to help inform and support the appropriate use of these therapies.