N28 Utilising Advanced Therapies in Inflammatory Bowel Disease: Real-World Experience from a UK Centre

Abstract Background Biologic therapy is a crucial aspect in the management of inflammatory bowel disease (IBD). Care equity and outcomes may be influenced by variability in prescription practices among clinicians. This study analysed the adoption of biologics among IBD patients in a large NHS Trust, comparing prescribing patterns across consultants to national and international standards. Methods We examined retrospectively 910 IBD patients’ electronic data (464 females and 446 males). Age information was available for 867 patients (mean age: 47.7 years, median age: 46 years). 552 patients had Crohn’s disease (CD), 351 ulcerative colitis (UC), and 7 had indeterminate colitis. Biologics and small-molecule medications included anti-TNFα (Adalimumab, Infliximab IV/SC, Golimumab), anti-integrin (Vedolizumab IV/SC), anti-IL12/23 (Ustekinumab), anti-IL23 (Risankizumab), JAK inhibitors (Tofacitinib, Upadacitinib, Filgotinib), and anti-IL23p19 (Mirikizumab). Data were stratified by sex, disease, and prescriber. Chi-square tests and coefficient of variation (CV) for inter-consultant prescribing variability were employed in statistical analysis. Results Local adoption mirrored national proportions, with Adalimumab accounting for 32% and Infliximab for 28% of biologic prescriptions, according to UK-wide audit statistics (BSG Biologic Audit, 2023). The observed shift toward subcutaneous Infliximab and Vedolizumab is consistent with global trends that support self-administration and service efficiency. Similar findings have been reported in recent European cohorts about female preponderance in IL23/IL12 therapy (ECCO Registry, 2024). The relatively high uptake of Upadacitinib reflects early Trust adoption of oral JAK inhibitors compared with the approximately 3% national average. Conclusion Although there is a substantial variability between consultants, the adoption of biologics within this large NHS Trust is consistent with national and international prescribing trends. The results corroborate the need for multidisciplinary assessment and standardization of biologic initiation pathways in order to optimize equality and consistency in advanced IBD treatment. Conflict of interest: Scott, Glyn: No conflict of interest Abreu, Beatriz: N/A Preziosi, Giuseppe: No conflict of interest Barbara, Sissi: No conflict of interest