S1944 Prospective Evaluation of Adherence to Early Clinical and Biochemical Assessments After Therapy Adjustment for Inflammatory Bowel Disease

Introduction: The treat-to-target (TTT) approach emphasizes time-based targets, however real-world adherence to early clinical and objective assessments after treatment adjustment is not well-described. Methods: This single center prospective cohort study included patients starting a new advanced therapy (AT), escalating current AT, or reinducing current AT for ulcerative colitis (UC) or Crohn’s disease (CD) from 8/1/2024 to 12/15/2024. The dates of decision for therapy adjustment and first doses were recorded prospectively; additional data were collected retrospectively. Data were collected in conjunction with IBD Qorus TTT improvement efforts. Primary outcomes were completion of clinical (office or video visit) or biochemical (C-reactive protein [CRP] or fecal calprotectin [FCP]) assessments within 16 weeks of treatment adjustment date. Assessments <2 weeks from this date were excluded. Results: 148 patients underwent treatment adjustment (49% UC, 51% CD). Median time to first dose was 28 days (n = 148, IQR 19-37), and was numerically shorter for single AT (26 days, n = 86, IQR 15-35) than combination AT (29 days, n = 20, IQR 20-44) and re-inductions/escalations (31 days, n = 42, IQR 21-36). 81% (n = 120) had on-time clinical assessments. On-time biochemical follow-up was less common, with 62% (n = 91) having any on-time biomarker (for CRP, n = 74 [50%]; for FCP n = 58 [39.1%]). Both clinical and biochemical (either CRP or FCP) assessment was performed on time in 59% (n = 87), falling to 27% (n = 40) if considering completion of both biomarkers. In multivariate logistic regression, new starts were more likely to have clinical follow-up (aOR 2.90, 95% CI 1.08-7.78) and Hispanics less likely (aOR 0.25, 95% CI 0.07-0.94). Older age (aOR per year 0.97, 95% CI 0.94-0.99) and longer time from decision to start (aOR per day 0.97, 95% CI 0.95-0.99) were associated with lower odds of biochemical follow-up. Non-infusion induction and corticosteroid use were associated with higher odds of biochemical follow-up in univariable but not multivariable analysis. Conclusion: In this prospective single-center study, 1/5 of patients did not undergo clinical assessment and over 1/3 lacked biochemical assessment within 16 weeks of actual start date for a new AT or new AT dosing. If low rates of early TTT assessments are confirmed with multicenter data, adherence to these assessments could prove to be a more impactful quality improvement focus than later targets such as endoscopy.