2928 Patients With Severe Ulcerative Colitis Are Infrequently Treated With Anti-TNFs in a County Hospital

• Published in: The American journal of gastroenterology Vol. 114; no. 1; p. S1596
• Main Authors: Penninti, Pranav, Pham, Codey, Coss, Elizabeth, Govani, Shail
• Format: Journal Article
• Language: English
• Published: 01.10.2019
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/01.ajg.0000601244.83350.d4

INTRODUCTION: Patients with ulcerative colitis (UC) are prone to flares, many of which require hospitalization for administration of corticosteroids. Patients hospitalized with UC may need rescue therapy with anti-TNFs to prevent colectomy. We aimed to study outcomes for patients being treated for UC with corticosteroids at a county hospital in Texas. METHODS: A retrospective review of all hospitalizations with an ICD9/10 codes consistent with UC was performed from 2015 to 2017. The charts were manually reviewed to confirm the diagnosis of UC and to determine the hospital course. We included patients admitted for UC flare treated with either oral or intravenous (IV) corticosteroids and found to have severe UC on endoscopic exam. Patients with <30 days of follow up were excluded from evaluation unless they underwent colectomy after admission. Descriptive statistics were calculated using SAS 9.4. RESULTS: A total of 118 admissions for UC were reviewed. Of these 19 met our inclusion/exclusion criteria. The median age was 41 years [IQR: 26-53], 12 (63.2%) were of Hispanic ethnicity, 12 were female (63.2%) with a median disease duration of 4 years [IQR: 2-6]. Two patients (10.5%) were on anti-TNFs prior to admission. Median CRP on arrival was 5.8 mg/dL [IQR: 2.8-8.5] and median albumin was 2.9 g/dL [IQR: 2.5-3.0]. The majority (63.2%) were treated with oral steroids versus IV steroids. None of the patients were initiated on an anti-TNF during admission. After discharge, 5 patients were initiated on anti-TNFs. Three (15.8%) underwent colectomy within 90 days of admission. None of the 5 patients initiated on anti-TNF underwent colectomy within 90 days compared to 2 of the 12 (16.7%) who were not started on anti-TNF ( P = 1.0). Patients without insurance were initiated on anti-TNF in 22.2% of cases compared to 37.5% of cases in which the patient had insurance coverage ( P = 0.62). CONCLUSION: In this small study of patients admitted for severe ulcerative colitis, anti-TNF use was not commonly initiated during or after hospitalization. Despite endoscopic and lab evidence of severity, the overall colectomy rate is relatively low in this population. Larger studies of this cohort are necessary to better understand the barriers to anti-TNF use and the long term outcomes of severe UC.