P0234Disease Activity using Physician Global Assessment (PGA) in Paediatric Inflammatory Bowel Disease (PIBD): An International Cross-Sectional Study

Background Reporting disease activity in large cohorts of children with Inflammatory bowel disease (PIBD) is difficult in part as the disease activity scores are not reliably completed in all patients. The scores used in PIBD (PUCAI/wPCDAI) were developed using the physician global assessment (PGA) as the standard when first developed. In this study we report overall disease activity scores at diagnosis and one year using PGA and compare these with data for PUCAI and wPCDAI scores for these patients. Methods PIBD-SET Quality Inception Cohort1 is an observational, prospective, multicentre study involving patients from ten countries. Data from patients with 1-year of follow up were retrieved and analysed. Disease activity scores (PGA, PUCAI, wPCDAI) at diagnosis and after 1 year of treatment, were reported. Completion rates and correlation of the PGA, PUCAI and wPCDAI scores in this cohort were reviewed. Additionally, pharmacological or nutritional therapies were examined. Results A total of 573 children (347 Crohn’s disease (CD), 192 ulcerative colitis (UC) and 34 IBDU) with a mean age of 12.90 years (± 3.1 years) were included. UC and IBDU data were combined. At diagnosis disease activity (for CD and UC/IBDU respectively) using PGA were severe; 18.4% & 19%, moderate; 42.1% &36.7%, mild; 34.5% & 35.8% remission; 5% & 3.9%. Mean wPCDAI and PUCAI at diagnosis were 46 and 40. At one year, disease activity scores showed 67.4% of all patients were in remission as reported by PGA (69.6% CD; 63.2% UC/IBDU). When using wPCDAI <10 and PUCAI <12.5 at one-year to define remission results were similar to PGA showing 70.3% and 67.6% respectively. At 1-year PGA for CD and UC/IBDU respectively showed, mild; 26.6% & 24.5%, moderate; 3.5% &11.4%, and severe; 0% & 0.9%. PGA and PUCAI were similar in their completion rates at over 90% (Table 1), wPCDAI was lower than the other scores at both timepoints. There were positive correlations between PGA/wPCDAI [r = 0.780, p = <.001] and PGA/PUCAI [r = 0.692, p = <.001]. At 1-year, CD patients received more biologics (64.8% v 34.1%) and immunomodulators (68.6% v 59.1%) but less corticosteroids (7.2% v 26.6%) and 5-ASA (6.3% v 79.2%) as compared to UC/IBDU patients. Conclusion In this large multinational cohort after one-year clinical remission rates are approximately 70% for CD and 63% for UC/IBDU, providing benchmarks for other centres to review their services. Results indicate that PGA is feasible to complete and produces similar results to the more detailed wPCDAI and PUCAI scores. Completion rates of wPCDAI even in a planned and funded prospective cohort are lower than both. Further work is being undertaken to compare centres/countries’ data to identify higher remission rates and more successful treatment strategies. Reference: Aardoom MA, Kemos P, Tindemans I, et al. International prospective observational study investigating the disease course and heterogeneity of paediatric-onset inflammatory bowel disease: the protocol of the PIBD-SETQuality inception cohort study. BMJ Open. 2020;10(7):e035538. Published 2020 Jul 1. doi:10.1136/bmjopen-2019-035538 Conflict of interest: Dr. Young, Aaliyah: No conflict of interest Edwards, Shannon: No conflict of interest Camman, Anouk: No conflict of interest Croft, Nicholas Michael: Eli Lilly/PI/co-PI Clinical (drug) trial costs, all paid to institution Abbvie/PI/co-PI Clinical (drug) trial costs, all paid to institution Jansenn/PI/co-PI Clinical (drug) trial costs, all paid to institution Takeda/PI/co-PI Clinical (drug) trial costs, all paid to institution Pfizer/PI/co-PI Clinical (drug) trial costs & consultancy, all paid to institution de Ridder, Lissy: No conflict of interest