ADVANCED THERAPY UTILIZATION AND HEALTHCARE VISIT PATTERNS IN PATIENTS WITH CROHN’S DISEASE: A PRELIMINARY LONGITUDINAL ANALYSIS FROM IBD QORUS

Abstract INTRODUCTION Advanced therapies (AT) are increasingly used in the management of inflammatory bowel disease (IBD), yet real-world data describing treatment initiation, persistence, and associated outcomes remain limited. We aimed to evaluate AT utilization, healthcare visit frequency, and steroid-free healing in Crohn’s disease (CD) using a longitudinal dataset. METHODS Survey responses from patients and providers were prospectively gathered through IBD Qorus at 48 academic and community practices during routine visits from November 2020 to May 2025. We included patients with recorded, current medication use and IBD classification of CD who consented to longitudinal reporting of data. We report descriptive statistics of AT use rates over time. A Kaplan–Meier analysis was performed to compare the time to steroid-free healing between patients on and off AT. RESULTS Among the 4,314 included CD patient-visits, 79% (N = 3,428) reported advanced therapy use. Of the 1,752 unique patients identified, 84% were on AT within the longitudinal dataset. Among these patients on AT, 38% were treated with TNFi, 24% with ustekinumab, 12% with vedolizumab, and 5% with IL-23 inhibitors. There was a decrease in the utilization of TNFi, ustekinumab, and vedolizumab, accompanied by an increase in the use of IL-23 inhibitors and small molecule therapies, almost exclusively driven by upadacitinib (Figure 1). Patients had a median of 2 visits within the dataset (IQR: 2). 100 patients were started on AT and 8 patients were started on combination therapy during the study period. By 26 months from the initial visit, the probability of achieving steroid-free healing approached 80% and was not significantly different between patients on and off AT (Figure 2). DISCUSSION In this large CD cohort, AT use exceeded 80%, likely reflecting adherence to guidelines and treat-to-target goals among engaged patients and providers in Qorus. The low frequency of office visits may indicate that patients already on AT are achieving sustained symptom control, reducing the need for frequent follow-up. The absence of a difference in steroid-free healing suggests appropriate treatment selection, with the majority of patients on AT requiring therapy and those not on AT also being well-managed without it. This is consistent with population-based studies suggesting that 20-30% of patients with CD have mild disease and may not benefit from these advanced therapies (1). Ongoing analyses of patients starting on AT, focusing on healthcare utilization and clinical outcomes, will be essential to defining the real-world drivers of therapy use. References 1. Claytor J, Kumar P, Ananthakrishnan AN, Colombel JF, Agrawal M, Ungaro RC. Mild Crohn’s Disease: Definition and Management. Curr Gastroenterol Rep. 2023;25(3):45-51. https://doi.org/10.1007/s11894-023-00863-y