A0388 - Early Biologic or Small Molecule Therapy Initiation After Index Hospitalization for an Ulcerative Colitis Flare Prevents Re-Hospitalization

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

GK

Gursimran S. Kochhar, MD

Allegheny Health Network
Pittsburgh, PA

Gursimran S. Kochhar, MD¹, Aakash Desai, MD², Raymond Cross, MD³, Corey A. Siegel, MD, MS⁴, Stephen B. Hanauer, MD⁵, Parambir S. Dulai, MD⁵
¹Allegheny Health Network, Pittsburgh, PA; ²MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH; ³University of Maryland Medical Center, Baltimore, MD; ⁴Dartmouth-Hitchcock Medical Center, Lebanon, NH; ⁵Northwestern University, Chicago, IL

Introduction: Ulcerative colitis (UC) patients hospitalized for acute flares are at an increased risk for re-hospitalization. A recent RAND panel recommended early (within 3 months) biologic or small molecule therapy initiation post-discharge; however, evidence supporting this strategy is limited. We aimed to quantify the impact of early biologic or small molecule therapy initiation post-discharge on the risk of re-hospitalization in UC patients

Methods: A retrospective cohort study was conducted using TriNetX, a multi-institutional database of more than 70 million patients in the USA. We included UC patients with no prior exposure to biologics or small molecules, hospitalized for the first time, and started on intravenous steroids. We compared re-hospitalization rates for a UC flare at 1- and 2 years based on the timing of medical therapy initiation in-hospital or post-discharge. 1:1 propensity-score matching was performed for age, gender, race, ethnicity, BMI, baseline Hemoglobin (Hgb), C-reactive protein (CRP), and albumin. Odds ratios (OR) with 95% confidence interval (CI) were calculated

Results: A total of 1,203 biologic and small molecule naïve UC patients were hospitalized for an acute flare. Patients were treated with methylprednisolone (74%), with a median CRP of 45.1 and albumin of 3.37 on admission. Re-hospitalization for a flare was observed in 338 (28%) by 3 months and 548 (46%) by 12 months. Inpatient biologic (infliximab) or small molecule (cyclosporine) therapy was used in only 12% of patients, and early post-discharge initiation of a biologic was observed in only 27% of patients. Delayed (between 3-12 months post-discharge) initiation of a biologic or small molecule was associated with a significantly higher risk for re-hospitalization at 1- (OR 1.47, 95% CI 1.01-2.15) and 2 years (OR 1.65, 95% CI 1.14-2.41) post-discharge. No significant differences were observed in re-hospitalization risk among patients starting a biologic or small molecule in-hospital versus within 3 months of discharge (OR 1.15, 95% CI 0.68-1.95). A total of 133 (11%) patients were not started on a biologic or small molecule until > 12 months, and only after they had already been re-hospitalized for a second flare

Discussion: Biologic and small molecule naïve UC patients hospitalized for an acute flare are at a significantly increased risk for re-hospitalization up to 1-year later. Initiation of biologics or small molecules within 3 months of discharge is associated with a reduction in risk for re-hospitalization

Disclosures:

Gursimran Kochhar: GIE Medical – Advisor or Review Panel Member. Lilly Pharma – Advisor or Review Panel Member.

Aakash Desai indicated no relevant financial relationships.

Raymond Cross: Abbvie – Advisory Committee/Board Member, Consultant. BMS – Advisory Committee/Board Member. Fzata – Consultant. Janssen – Advisory Committee/Board Member, Grant/Research Support. Magellan Health – Consultant. Pfizer – Advisory Committee/Board Member, Consultant. Samsung bioepis – Consultant. Takeda – Advisory Committee/Board Member.

Corey Siegel: Abbvie – Consultant, Grant/Research Support. Jannsen – Consultant. Lilly – Consultant, Grant/Research Support. MiTest Health, LLC – Intellectual Property/Patents, Owner/Ownership Interest. Napo Pharmaceuticals – Consultant. Pfizer – Advisor or Review Panel Member, Consultant, Grant/Research Support. Prometheus – Consultant. Prometheus Biosciences – Consultant. Takeda – Advisor or Review Panel Member, Grant/Research Support, Royalties.

Stephen Hanauer: Abbvie – Advisor or Review Panel Member, Advisory Committee/Board Member, Grant/Research Support, Speakers Bureau. allergan – Consultant, Grant/Research Support. Amgen – Consultant, Grant/Research Support. Arena – Advisor or Review Panel Member, Advisory Committee/Board Member. BMS – Advisory Committee/Board Member, Grant/Research Support, Speakers Bureau. Boehringer-Ingelheim – Advisor or Review Panel Member, Advisory Committee/Board Member. gilead – Consultant, Grant/Research Support. gossamer – Advisor or Review Panel Member. gsk – Consultant, Grant/Research Support. Janssen – Advisor or Review Panel Member, Advisory Committee/Board Member, Consultant, Grant/Research Support, Speakers Bureau. lilly – Grant/Research Support. Merck – Consultant. Novartis – Consultant. Pfizer – Advisor or Review Panel Member, Advisory Committee/Board Member, Speakers Bureau. prometheus – Advisory Committee/Board Member, Consultant, Grant/Research Support. Protagonist – Advisor or Review Panel Member, Advisory Committee/Board Member. seres – Consultant. seres therapeutics – Consultant. Takeda – Advisor or Review Panel Member, Advisory Committee/Board Member, Consultant, Speakers Bureau.

Parambir Dulai: BMS – Consultant. DigbiHealth – Stock Options. Gilead – Consultant. Janssen – Consultant. Lily – Consultant. Novartis – Consultant. Pfizer – Consultant, Grant/Research Support. PreciDiag – Royalties. Takeda – Consultant, Grant/Research Support.

Gursimran S. Kochhar, MD¹, Aakash Desai, MD², Raymond Cross, MD³, Corey A. Siegel, MD, MS⁴, Stephen B. Hanauer, MD⁵, Parambir S. Dulai, MD⁵. A0388 - Early Biologic or Small Molecule Therapy Initiation After Index Hospitalization for an Ulcerative Colitis Flare Prevents Re-Hospitalization, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.