Is High Globulin Fraction a Biomarker of Severity in Inflammatory Bowel Disease (IBD)? Analysis of a 6-Year, Prospective Natural History Registry

pre-index and 24 months post-index date.The index date is the date of the first diagnosis (CD or UC) in the database for each pt.In the CD analysis, pts' UC diagnoses were excluded, and vice versa.Sankey diagrams, used to visualize treatment pathways, depicted unique sequences of IBD treatments and quantified pts across different pathways.Treatment pathways were defined by the introduction of discreet agents in the patient's treatment course.A monotherapy (monotx) pathway was defined as the use of the same single agent, once or repeatedly, throughout the treatment course.Results: 16,260 CD and 28,120 UC pts were included.Corticosteroid (CS) monotx was the most common first-line agent (42%) and treatment pathway (26%) for CD pts.The CS monotx pathway represents nearly twothirds of pts initially using CS; 63% of these CD pts had ≥2 steroid cycles; 108 had ≥10 cycles in the observed period.5-ASA monotx was the second most common treatment pathway for CD (12%) and most common for UC (24%).CS monotx was the second most common pathway for UC pts (16%).Pts using 5-ASAs as initial treatment had a longer time to biologic initiation vs pts using other first-line therapies.Overall, biologic pathways were relatively rare (CD pts: 19%; UC pts: 6%), and even fewer pathways use biologics combined with other agents (CD pts: 15%; UC pts: 5%).The most common biologic pathway in these populations was adalimumab (ADA) monotx (CD pts: 0.5%; UC pts: 0.04%), followed by infliximab monotx (CD pts: 0.3%) or 5-ASA switching to ADA (UC pts: 0.03%).Conclusion: This real-world data analysis identified unique treatment pathways visualized through Sankey diagrams.Our findings indicate few pts are treated with biologics; of those using biologics, few receive combination therapy, despite support for this approach.These findings suggest current treatment guidelines and disease management recommendations may not be uniformly followed in the real-world setting. Sa1856