Disease Monitoring in Inflammatory Bowel Disease Daily Clinical Practice and Impact on Treatment Decision Making: Real World Evidence From the Inflammatory Bowel Disease-PODCAST Study

Background: Crohn's disease (CD) and ulcerative colitis (UC) are progressive inflammatory bowel diseases that often result in bowel damage, imposing a significant burden on patients with insufficient disease control due to the limited efficacy of current treatments or complex disease management. There are limited data on how disease monitoring informs treatment decisions in daily clinical practice. The IBD-PODCAST study aimed to estimate the proportion of Crohn's disease and ulcerative colitis patients experiencing suboptimal disease control in a real-world setting. Objectives: To evaluate disease monitoring practices and their impact on physicians' actions and treatment decisions for patients with suboptimal disease control. Methods: A non-interventional cross-sectional study was conducted across 103 sites in 10 countries. Criteria for suboptimal disease control were based on STRIDE-II criteria, adapted by an expert panel. Results: 2185 patients (Crohn's disease: n = 1,108, ulcerative colitis: n = 1077) with a mean (SD) age of 44.0 (14.8) years and disease duration of 12.4 (9.2) years were included. Suboptimal disease control was present in 52.2% of CD (n = 578) and 44.3% of UC patients (n = 477). Disease monitoring via imaging and/or endoscopy over a 12-month period was conducted in approximately 40% of the patients. In patients that were lacking annual monitoring via imaging/endoscopy and/or biochemical monitoring at index, an optimal disease status indicating no objective inflammation was observed in only 31.1% of CD and 36.4% of UC patients. In patients with suboptimal disease control, 391 CD (67.6%) and 324 UC (67.9%) had clinically relevant parameters. In around 50% of these patients, physicians took action. Conclusions: Annual disease monitoring via imaging/endoscopy was performed in only 40% of inflammatory bowel disease patients. Physicians modified treatment in approximately half of patients with suboptimal disease control and clinically relevant parameters. The study emphasized the importance of consistent monitoring and taking action when targets are not met to improve the quality of life of patients with inflammatory bowel disease.