P0199Longitudinal trajectories of disability in patients with Inflammatory Bowel Disease: a multicenter prospective study

Background Disability is increasingly recognised as a relevant long-term endpoint in inflammatory bowel disease (IBD), yet its prognostic value in clinical practice remains underexplored. Accordingly, we aimed to characterize the longitudinal trajectories of disability over time in patients with IBD. Methods This prospective multicenter study included IBD patients previously enrolled in the IBD-Disk validation cohort and followed for 24 months. Disability was assessed using the IBD-Disk. Moderate-to-severe disability was defined as a global score >40 (1,2). Demographic and clinical characteristics, including therapy, were collected at baseline. Patients’ disability was reassessed at 24 months. Clinical relapse, IBD-related hospitalisations, and therapeutic sequencing were also recorded Results Of the 402 patients initially enrolled, 304 (75.6%) completed the 24-month follow-up. Of these, 170 (55.9%) had ulcerative colitis (UC) and 134 (44.1%) Crohn’s disease (CD). At baseline, 131 patients (43.1%) with moderate-to-severe disability showed higher rates of clinically active disease compared with those with mild disability (60.3% vs 39.9%; p = 0.001). After 24 months, disability trajectories varied across patients. Among those with mild disability at baseline, 40 of 173 (23.1%) progressed to moderate-to-severe disability, while 59 of 131 (45.0%) with moderate-to-severe disability improved to mild disability [Fig. 1]. Nevertheless, the overall pattern of trajectories did not show significant directional asymmetry (McNemar test χ²=3.27, p = 0.070). Baseline moderate-to-severe disability was strongly associated with clinical relapse at 24 months (HR 2.37; 95% CI 1.39–4.06; p = 0.002), and this association remained significant after adjusting for sex, type of IBD, age, biological therapy, active disease, and extraintestinal manifestations. Moderate-to-severe disability also predicted IBD-related hospitalisations (HR 3.10; 95% CI 1.15–8.39; p = 0.026). In contrast, no independent association was observed between moderate-to-severe disability and treatment sequencing (HR 1.31; 95% CI 0.84–2.03; p = 0.23), although a trend toward significance was observed [Fig. 2]. Notably, treatment sequencing was strongly associated with active disease (HR 0.53; 95% CI 0.34–0.82; p = 0.004). Overall, 14 patients (4.6%) underwent surgery at 24 months, with no significant difference between patients with moderate-to-severe and mild disability (7.6% vs 2.3%; p = 0.055). Conclusion Moderate-to-severe disability was independently associated with a higher risk of clinical relapse and IBD-related hospitalisation over 24 months, supporting its role as a measure of comprehensive and sustained disease control. References: 1. Tadbiri S, et al. The IBD-disk Is a Reliable Tool to Assess the Daily-life Burden of Patients with Inflammatory Bowel Disease. Journal of Crohn’s and Colitis. 2021 May 4;15(5):766–73. 2. Tannoury J, et al. Determinants of IBD-related disability: a cross-sectional survey from the GETAID. Aliment Pharmacol Ther. 2021 May;53(10):1098–107. Conflict of interest: Dr. Nardone, Olga Maria: Advisory board fees from Eli Lilly, Nestlè, Janssen Speaker fees from AbbVie, Janssen, Eli Lilly, Ferring, Alfa Sigma, Recordati, Noòs, and Pfizer Calabrese, Giulio: Travel grant by Johnson and Johnson Speaker fee by Celltrion Caprioli, Flavio: Flavio Caprioli served as consultant to: Abbvie, Amgen, MSD, Takeda, Janssen, Roche, Celgene, Bristol-Meyers Squibb, Galapagos, Gllead, Pfizer, Mundipharma, Biogen, Ferring, Eli-Lilly, Nestlè, Lionhealth, AlfaSigma, Dr Falk, Celltrion, Abivax. He received lecture fees from Abbvie, Ferring, Takeda, Allergy Therapeutics, Janssen, Pfizer, Biogen, Sandoz, Tillotts Pharma, Vifor Pharma, AlfaSigma, Celltrion, Eli-Lilly. and unrestricted research grants from Giuliani, Sofar, MSD, Takeda, Abbvie, Celltrion, Pfizer, Actial. Fantini, Massimo Claudio: MCF has acted as a consultant for: AbbVie, AlfaSigma, Celgene, Celltrion, Gilead, Pfizer, MSD, Bristol-Meyer, Takeda, Johnson & Johnson, Roche, Galapagos, Biogen, Sandoz, Eli-Lilly, Lionhealth, Teva, Giuliani, Dr Falk Pharma, Sanofi he has received financial support for research from Johnson & Johnson and Pfizer. Onali, Sara: Consultant/lecture fees to: Abbvie, Alfasigma, MSD, Takeda, J & J, Galapagos, Pfizer, Eli Lilly Orlando, Ambrogio: Advisory board and/or lecture fees for: AbbVie, Galapagos, Celltrion, MAD, Sofar, Pfizer, Takeda, Cadigroup, Sandoz, Janssen, Eli-Lilly, Alfasigma Savarino, Edoardo Vincenzo: Personal Fees: Takeda, Abbvie, MSD, Janssen, Sofar Variola, Angela: Consultant for Abbvie, Alfasigma, Celltrion, Eli-Lilly, Johnson and Johnson, Takeda, Pfizer Speaker fee for Abbvie, Alfasigma, Celltrion, Eli-Lilly, Johnson and Johnson, Ferring, Takeda, Pfizer, Zamboni Vastarella, Josephine: No conflict of interest to declare Guarino, Alessia Dalila: No conflict of interest Rispo, Antonio: None Testa, Anna: Consultant /Advisory board for Abbvie, J & J, Takeda, Ferring Castiglione, Fabiana: Honoraria from: Takeda, AbbVie, Celltrion, Johnsson Johnsson, Cadigroup, Sandoz, Pfizer, Lilly, Lionhealth, Nestlè