Only one-third of Australian patients with ulcerative colitis achieve the current guideline goal of clinical and endoscopic remission, real world data shows.
And clinician related practice behaviours were the most common barriers to achieving the proposed ‘treat to target’ strategy set out in international consensus guidelines, according to the research from the IBD department at Royal Adelaide Hospital.
Presenting the findings of a multicentre retrospective study at the Australian Gastroenterology Week here in Adelaide Dr Robert Bryant told delegates: “Guidelines are all well and good but they need to be feasible and applicable to practice to have an impact on patients.”
In particular there was a failure by clinicians to seek and confirm objective evidence of remission at endoscopy in patients with clinical remission.
There was also a failure to objectively assess disease activity following the escalation of therapy in clinically active disease.
“It also seems that faecal calprotectin as a biomarker is grossly underused, at least in the centres evaluated during that time [of the study]” he told delegates.
“This highlights a gap between guidelines and clinical practice,” he said.
“Discordance between clinical and objective measures of inflammation emphasises the importance of objective assessment of UC disease activity,” he concluded.
The two part retrospective study involved over 250 UC patients, 61% of whom were in clinical remission, 35% were in clinical and endoscopic remission (Mayo endoscopic sub-score 0 or 1), and 26% in clinical, endoscopic, and histologic (Truelove and Richards index) remission.
Potential barriers to either achieving or documenting the combined clinical and endoscopic treatment target included failure to seek endoscopic confirmation of clinically quiescent disease (35%), failure to up-titrate therapy where clinically active (43%), and lack of endoscopic assessment following up-titration of UC therapy (35%).
Medication or appointment non-compliance was recorded in 15% of patients.