P49 Indicators for inadequate response to advanced therapy in ulcerative colitis: a UK medical chart review

IntroductionPatients with UC commencing advanced therapy may experience inadequate response or require therapy modification to achieve remission. Therapeutic modification increases healthcare costs and is associated with adverse events. This study aimed to examine the rates of inadequate response, therapeutic modification and subsequent remission among UC patients starting advanced therapy in the UK.MethodsUsing a retrospective chart review, patients with UC treated with an advanced therapy (adalimumab, infliximab, golimumab, vedolizumab, tofacitinib) during 01/2017–09/2019 were selected from 8 UK clinics. Patients with ≥12 months of data before and after starting an advanced therapy (Index Date) were included. Inadequate response was defined as >1 event of: index therapy discontinuation or switch due to lack of response, therapy escalation, augmentation with an additional conventional therapy, corticosteroid (CS) dependency (use for ≥12 weeks), new CS initiation, UC-related hospitalisation, surgery, or emergency department visit. Remission was assessed using Mayo score components. Kaplan-Meier analysis examined remission rates over 24 months. Subgroups included patients with prior exposure to biologics, and patients with vs without remission at 12 months. Factors associated with time to remission were assessed in a multivariate Cox regression model.ResultsAmong 238 patients included (female: 46.6%; median 42 years; median follow-up: 28.8 months), 178 (74.8%) patients were biologic-naïve and 60 (25.2%) were biologic-experienced. At 12 months, 105 (44.3%) patients had experienced ≥1 indicator for an inadequate response (Figure 1); median time to first event was 18 months. Among those who discontinued (N=72), 69.4% switched to another advanced therapy. Inadequate response was more frequent in biologic-naïve vs experienced patients (50.3% vs. 26.7%; p