P0950 Comparing Real-World use of Dietary and Medical Therapies in Children and Adults with IBD

Background

Approximately 10% of people with inflammatory bowel disease (IBD) are diagnosed before 18 years of age. We explored the real-world use of dietary and medical therapies across the age spectrum in people with IBD under routine ambulatory care in Australia and New Zealand (ANZ).

Methods

Crohn’s Colitis Care (CCCare) is an IBD-specific electronic medical record (EMR) used across ANZ. De-identified data from CCCare’s linked clinical quality registry were analysed in September 2024. All people with IBD under active care (clinical encounter within the prior 14 months) were included. Children were defined as being < 18 years of age at time of extraction.

Results

A total of 7506 people with IBD were included in the study. In the <18 years age group (n=315), 58.7% were male with a median age of 16 (IQR 14-18). The majority resided in Australia (83.8%, n=264), and most had Crohn’s disease (65.1%, n=205). In the ≥18 years age group (n=7191), 45.6% (n=3494) were male with a median age of 43 years (IQR 32 - 57). The majority (72.6%, n=5223) resided in Australia, and over half had Crohn’s disease (55.4%, n=3982). Interestingly, 5-aminosalicylate use was more prevalent in adults than children (37.2% vs 27.4% respectively, P<0.001), whereas current immunomodulator use was less common in adults compared to children (32.2% vs 61.0% respectively, P<0.001). Steroid use within the past year was close to 10% in both cohorts (11.1% for the paediatrics cohort and 8.5% for adults, P=0.11). Over half of the paediatric and adult cohorts were on an advanced therapy (biologic or novel small molecule) (57.8% and 51.4% respectively, p<0.05). Advanced therapy use by age group is shown below.

Anti-TNF therapies (infliximab and adalimumab) predominated in the paediatric cohort. Across the cohort, infliximab use decreased with age, whereas vedolizumab use increased with age. Dietary therapies were infrequently used/documented, with only 13/315 (4.1%) receiving dietary therapy in the paediatric cohort and 53/7191 (0.7%) in the adult cohort (p<0.001).

Conclusion

This study highlights CCCare’s ability to facilitate clinical research involving individuals of all ages with IBD, as well as to monitor therapy choices within a large, real-world cohort in real time. The findings provide intriguing insights into the variation in the use of dietary and advanced therapies. While certain differences in advanced therapy usage may be attributed to licensing and funding arrangements, others may be linked to concerns over drug safety in older populations. Future efforts aimed at correlating these therapeutic choices with outcomes, complications, and associated costs will soon enable a comparative evaluation of treatment strategies.