Treat-to-Target Monitoring Adherence and Rates of Healthcare Utilization in Patients With Inflammatory Bowel Disease...

The aim of treat-to-target (T2T) algorithms in inflammatory bowel disease was to maximize the benefit of medical therapies by establishing a framework for disease activity assessment to guide therapeutic decisions. There are limited data on adoption rates of T2T monitoring in real-world practice. We aimed to describe rates of T2T monitoring, predictors of completion, and associations with clinical outcomes.

A retrospective cohort study was conducted from 2015 to 2021 of individuals with inflammatory bowel disease starting new biologic or small molecule therapy within a multistate healthcare system. The completion of biochemical monitoring including fecal calprotectin or C-reactive protein and structural monitoring including endoscopy or enterography, or both, was assessed between 3 and 6 months and 6 and 12 months, respectively. Healthcare utilization (HCU), defined as emergency department visits, hospitalizations, prednisone prescriptions, or abdominal surgery within 2 years, was also assessed.

A total of 823 patients were included in the cohort, and 127 (15.4%) completed some form of T2T monitoring. Twenty-two patients (2.7%) completed both biochemical and structural monitoring. The completion of T2T was not associated with lower HCU. The completion of only biochemical T2T, but not structural or both biochemical and structural T2T, was associated with decreased 12-month medication persistence (hazard ratio 0.36, 95% confidence interval 0.17-0.75). The completion of just structural T2T (hazard ratio 1.59, 95% confidence interval 1.05-2.39) was associated with higher HCU.

In this retrospective cohort of individuals initiating new therapy, the rates of T2T monitoring were low. The completion of all T2T was not associated with lower HCU. The completion of only biochemical T2T monitoring was associated with lower 12-month medication persistence and only structural T2T with higher HCU.