The following is a summary of “Utilization of Treat-to-Target Monitoring Colonoscopy After Treatment Initiation in the US-Based Study of a Prospective Adult Research Cohort With Inflammatory Bowel Disease,” published in the September 2023 issue of Gastroenterology by Yang, et al.

Endoscopic healing is a crucial target for treating inflammatory bowel disease (IBD) and has been linked to better long-term clinical outcomes. However, there was limited information about how often patients receive colonoscopies to assess endoscopic healing after starting a new IBD treatment in real-world clinical practice. For a study, researchers sought to determine the proportion of patients in the Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) who underwent colonoscopy within 3–15 months after initiating a new IBD treatment.

The study identified patients in SPARC IBD who had started a new treatment with a biologic medication (including infliximab, adalimumab, certolizumab pegol, golimumab, vedolizumab, and ustekinumab) or tofacitinib. They calculated the percentage of patients who had colonoscopies within 3–15 months following the initiation of their IBD treatment and examined the usage patterns across different patient subgroups.

Out of 1,708 eligible treatment initiations between 2017 and 2022, the most commonly prescribed medications were ustekinumab (32%), infliximab (22%), vedolizumab (20%), and adalimumab (16%). The median age of patients was 38 years, with 66% having Crohn’s disease, 55% being female, and 12% being non-White. Within 3–15 months after starting their medication, 49.3% (with a 95% CI of 46.2%–52.5%) of patients received a colonoscopy. Colonoscopy usage was similar between patients with ulcerative colitis and Crohn’s disease. Still, it was more common among male patients, those over 40, and those with colonoscopies within three months of treatment initiation. The frequency of colonoscopy varied between different study sites, ranging from 26.6% (with a CI of 15.0%–38.3%) to 63.2% (with a CI of 54.5%–72.0%).

The study found that approximately half of the patients in SPARC IBD received colonoscopies within 3–15 months after starting a new IBD treatment, indicating limited adherence to the treat-to-target approach for assessing mucosal healing in routine clinical practice. The variation in colonoscopy usage between different study sites suggested a lack of consensus. It highlighted the need for more robust evidence regarding whether regular monitoring of colonoscopy is associated with improved patient outcomes.

Source: journals.lww.com/ajg/abstract/2023/09000/utilization_of_treat_to_target_monitoring.23.aspx