To evaluate the prevalence, characteristics, management, and outcomes of difficult-to-treat inflammatory bowel disease (DTT-IBD) and its clinical significance.
Key Findings:
24.8% of IBD patients met at least one DTT-IBD criterion.
77% of DTT-IBD patients failed at least two mechanisms of action.
Risk factors for DTT in UC included left-sided and extended colitis (OR 6.55; 95% CI, 1.93-40.98; p = 0.011 and OR 10.12; 95% CI, 3.01-63.14; p = 0.002).
In CD, risk factors included multiple localizations (L3+L4) (OR 3.04; 95% CI, 1.09-8.34; p = 0.03), stricturing (OR 2.24; 95% CI, 1.52-3.34; p < 0.001), penetrating behaviors (OR 2.33; 95% CI, 1.55-3.53; p < 0.001), and perianal disease (OR 2.49; 95% CI, 1.75-3.53; p < 0.001).
Delay in treatment initiation was positively associated with DTT in CD (OR 1.74; 95% CI, 1.27-2.41; p = 0.001) but protective in UC (OR 0.65; 95% CI, 0.45-0.93; p = 0.019).
Lower rates of symptomatic, biochemical, and endoscopic remission in DTT-IBD compared to non-DTT-IBD.
Interpretation:
DTT-IBD is prevalent in approximately one-quarter of IBD patients, with specific phenotypes and treatment delays contributing to its occurrence, highlighting the need for timely intervention.
Limitations:
Retrospective design may introduce bias, potentially affecting the reliability of the findings.
Exclusion of patients enrolled in clinical trials or receiving experimental drugs may limit generalizability.
Conclusion:
DTT-IBD is common in tertiary care settings, with specific IBD phenotypes and treatment delays identified as risk factors. Drug persistency decreases with each subsequent line of therapy, emphasizing the need for improved management strategies.
