Introduction: There are limited data on the effect of COVID19 on inflammatory bowel disease (IBD) service provision and prescribing practices Aims \u0026 Methods: We aimed to quantify the effects of COVID19 on our IBD service This included evaluation of service provision, prescribing practices and use of therapeutic drug monitoring (TDM) This is a single centre retrospective observational cohort study We extracted data from our local IBD databases, electronic patient records and radiology and endoscopy reporting systems between 16/3/20-17/4/20 and the corresponding period in 2019 To evaluate differences in prescribing practices we compared treatment decisions, made for patients with active disease in our biologic and immunosuppressant multidisciplinary meeting We then reviewed the characteristics of patients who had been commenced on, or had switched, biologic therapy To compare these cohorts we used Fisher\u0027s exact test for categorical data and Mann-Whitney test for continuous variables Descriptive statistics were used for prescribing practices and service provision Results: Amongst patients initiating IBD therapy, a higher proportion were commenced on biological therapy during COVID19 compared with prepandemic (29/45, 64% vs 19/50, 38%) We compared characteristics of patients commencing on or switching biologic therapy pre-COVID19 (n=37) and during COVID19 (n=36) The cohorts had similar IBD phenotypes, age of onset as well as disease extent/distribution In the pre-COVID19 cohort the median age was higher (36 vs 29 years, p=0 02) and median disease duration was longer (9 3 vs 5 2 years respectively, p=0 009) During COVID19 there was an increase in the proportion of patients receiving vedolizumab (22% vs 39%), adalimumab (19% vs 25%) and ustekinumab (24% vs 28%), while infliximab and tofacitinib prescribing fell (14% vs 3% and 8/37 vs 2/36 respectively) Across all biologic classes there was a reduction in concomitant immunomodulator prescribing and a tendency towards prescribing biologics in immunomodulator-naive patients New prescriptions of thiopurines for any indication fell by 96% (28 vs 1) During COVID19 there was a preference for vedolizumab or ustekinumab compared to the preceding year (24/36, 67% vs 17/37, 46%) and this cohort was more likely to be TNF-naive 18/24 (75%) vs 3/17 (18%) pre-pandemic Use of TDM fell by 75% during the pandemic (240 vs 59 tests pre- and during pandemic respectively) Values for thiopurine metabolites and anti- TNF levels pre- and during COVID19 were 143 vs 44 samples and 97 vs 15 samples respectively The number of patients seen in outpatient clinics was reduced by 68% Similarly, the number of MRI scans, lower gastrointestinal endoscopies or abdominal operations fell by 87%, 85% and 100% respectively Conversely, clinical nurse specialist and pharmacy helpline contacts increased by 76% and 300% respectively Conclusion: We observed prescribing differences during COVID19, bypassing the initiation of immunomodulators and/or anti-TNF therapy for active disease in favour of newer biologic agents, predominantly as monotherapy Judging by the difference in disease duration between the two cohorts, there appeared to be a shift to earlier prescription of biologics We also observed a rapid reorganisation of service provision that included a shift towards telemedicine and online solutions

Introduction Increasing vedolizumab (VDZ) dosing frequency to recapture response has been shown to be effective in clinical trials but there is limited real-life data from the clinical practice. In this study we assessed whether VDZ dose escalation helped recapture response in a large cohort of patients in a tertiary referral IBD centre. Methods A retrospective cohort study was performed by reviewing prospectively recorded clinical data for patients who received VDZ between November 2014 and October 2017. Patients who had sub-optimal response and had been escalated to 6 or 4 weekly infusions were identified. Data collected for demographics, previous biologic exposure, concomitant immunomodulators (IM), steroid use (SU), clinical disease activity for CD (HBI) and UC (SCCAI), and CRP levels at baseline, 12 and 24 weeks after dose escalation. Of the total 139 patients on VDZ, 36 (27%) had been escalated to Q4 (30) or Q6 (6), of whom 5 were further escalated to Q4 (72% male, median age 44, previous biologics exposure 81%, 49% concomitant IM and 16% SU at time of escalation). 18 patients had CD (50%), 14 UC (39%), and 4 (11%) IBD-U which were included in the UC group for the purpose of analysis. Duration of VDZ before and after dose escalation with a median of 7 m (ranges 0–22, 2–25 respectively). Currently 76% remain on VDZ after dose escalation (median 7 m after escalation). Clinical response was defined as HBI or SCCAI reduction >3. Remission as HBI <5 or SCCAI <3. Paired HBI, SCCAI, CRP values at baseline, week 12 and 24 were compared using Wilcoxon signed-rank test Results Patients with CD had a median HBI of 4 (range 0–27), 4 (0–29) and 3 (0–8), at baseline, 12 and 24 weeks. In UC group, the median SCCAI was 6 (range 0–11); 4.5 (1–11), and 4 (0–10), at baseline, 12 and 24 weeks. CRP for both groups at baseline was a median of 6 (1–23), 5 (1–46) at w12, and 2 (1–17) at w24. HBI and SCCAI at baseline, 12 and 24 weeks after dose escalation Statistically significant differences were noted in the UC group between SCCAI at baseline and after 24 weeks (p 0.01) and overall CRP at baseline and 24 w (p 0.04). Of all patients with clinically active disease at baseline (n=20), 5 achieved clinical response (25%), an additional 4 achieved clinical remission (20%).Abstract PWE-005 Figure 1 Conclusions In a real life setting, increasing dosing frequency in patients with sub-optimal response to VDZ is effective in approximately half of patients and should be considered as an intervention.

Introduction Vedolizumab was recently granted NICE approval for moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC). Novel pathways agreed by our CCG meant that patients at Guy’s & St. Thomas’ and King’s College Hospitals had early access to vedolizumab. Methods Records of patients commencing vedolizumab between Nov 2014–15 were screened. Those completing at least 14 weeks of treatment were included. Clinical activity was assessed using Harvey-Bradshaw Index (HBI) or Simple Clinical Colitis Activity Index (SCCAI) at baseline, 14 and 30 weeks. Response: HBI/SCCAI reduction ≥3. Remission: HBI < 5 or SCCAI <3. Continuous data are summarised as medians (range). Pre- and post-induction values were compared using Wilcoxon signed-rank test. Results 60 patients (CD: 32, 53%, UC 25, 42%, IBD-U 3, 5%) commenced vedolizumab (m:f 29:31, age: 39 (18–74), follow-up: 5 months (1–13)). 19 were excluded from our analysis (3 IBD-U, 5 stomas, 11 treated for <14 weeks). Clinical data from the remaining 41 was analysed. Of 32 patients with active disease at baseline, 17 (53%) responded and 11 (34%) achieved remission by week 14. The response and remission rates for CD were 8/15 (53%) and 6/15 (40%). In UC they were 9/17 (53%) and 5/17 (29%). Response and remission rates in anti-TNF experienced patients were 12/26 (46%) and 6/36 (35%) compared to 5/6 (83%) and 5/6 (83%) in anti-TNF naïve patients, respectively. 7/11 (64%) with active disease at baseline who completed 30 weeks of treatment responded and achieved remission. Faecal calprotectin fell significantly (pre-induction: 1076 (90–4800), post-induction: 478 (10–3184), p = 0.029 for n = 14) and CRP remained stable (pre-induction: 4 (1–70), post-induction: 4 (1–72), p = 0.28 for n = 40). Rates of steroid use at each time point: 19/41 (46%) at baseline, 11/41 (21%) at week 14 and 3/15 (20%) at week 30. Surgery was required in 4/41 (10%, CD:3 and UC:1). Conclusion Our experience mirrors a previously reported real-world cohort1 and demonstrates similar efficacy to the GEMINI trials. This data demonstrates a meaningful reduction in clinical and biochemical disease activity as well as a steroid-sparing effect in patients with complex and previously refractory disease. We did not see a significant difference in efficacy between patients with UC and CD. Reference 1 Christensen B. et al. Post-marketing experience of vedolizumab for IBD: The University of Chicago experience. ECCO; Barcelona, 2015. Disclosure of Interest None Declared

Introduction The deleterious effect of faecal incontinence (FI) on quality of life (QOL) is well documented. People with FI experience stigma, embarrassment and social exclusion, and report adverse effects on activities and relationships. Restoration of continence is associated with improvement in QOL. Diarrhoea is associated with increased prevalence of FI and, therefore, people with inflammatory bowel disease (IBD) are at risk. Methods To investigate how frequently health care professionals (HCPs) assess FI in a cohort of patients with IBD we performed a cross sectional survey of 380 adults attending a tertiary referral IBD clinic. Patient surveys were: the validated ICIQ-B questionnaire, detailing frequency and severity of bowel pattern, control and quality of life; and the non-validated Bowel Leakage Questionnaire, detailing any prior interventions by health care professionals. Demographics of age, gender, diagnosis, Montreal classification, St Mark’s Continence Score and disease activity were also recorded. Data was entered into a database and analysed using SPSS statistical package. Results 229/380 (60%) had Crohn’s Disease (CD) and 180/380 (47%) were female. Median age was 38 years (IQR:31–50) with a median disease duration of 8.7 years (3.4–15.1). 343/380 (90%) had experienced incontinence of flatus or faeces while 255/380 (67%) reported FI. Only 136/380 (36%) had been asked about FI during an encounter with a HCP. Of the people who had been asked about FI, the vast majority had been asked in IBD clinics (130/136, 96%). Fewer enquiries were made by HCPs in a primary care setting with 42/136 (31%) people having been asked by a family doctor and 12/136 (9%) by a practise nurse. A minority of patients spontaneously volunteered information about incontinence to a healthcare professional (146/380, 39%). Of the people who had discussed continence issues with a HCP, 55 (38%) were offered specific advice or referral for treatment. Those who volunteered information regarding continence had worse ICIQ-B control scores (9 (6–14) vs 3 (1–8), p < 0.0001)) and quality of life scores (16 (11–20) vs 9 [6–14], p < 0.0001), reflecting greater burden of disease. Conclusion Faecal incontinence is common in IBD. It is both under-reported by patients and under-recognised by healthcare professionals. Because symptoms and QOL can be significantly improved with appropriate intervention, HCPs need to enquire about FI as part of routine assessment. Disclosure of Interest None Declared