Basic therapy for inflammatory bowel diseases in St. Petersburg, Russia: results of a multicenter study

Background. Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), are the focus of attention of researchers and practitioners around the world due to the progressive course, the high risk of developing disabling complications and the difficulties of therapy. In St. Petersburg, the prevalence of CD is about 72 cases per 100 thousand people, the prevalence of UC is about 90 cases per 100 thousand people. Aim. Evaluation of the basic treatment regimens used in outpatient and inpatient practice of basic therapy of IBD in St. Petersburg, Russia. Materials and methods. The multicenter cross-sectional study was performed. Data about drug therapy, disease features and demographic from 42 outpatient institutions and from 6 city hospitals for the period 2018-2020in St. Petersburg was collected. The analysis included retrospective data of 874 patients (CD - 43.7%, UC - 56.3%) and was not included data from the specialized IBD city hospital department. To assess the degree of heterogeneity of approaches to the appointment of immunosuppressants and glucocorticoids in various institutions, a neural network analysis was performed. Results of the study. As a result of the assessment of the structure of IBD therapy, four main combinations of therapy used were identified: therapy with 5-aminosalycilic acid drugs alone (oral and/or rectal) without other drugs using (CD - 67.5% and 46.3%, UC - 84.2% and 37.5% in outpatient and inpatient practice, respectively); glucocorticoid therapy in combination with any 5-aminosalycilic acid drugs or as monotherapy (CD - 8.6% and 32.5%, UC - 6.9% and 36.8% in outpatient and inpatient practice, respectively); immunosuppressive therapy in combination with any other drugs, with the exception of biologics, or as monotherapy (CD - 12.9% and 11.3%, UC - 3.7% and 11.8% in outpatient and inpatient practice, respectively); biologics as monotherapy or in combination with any other drugs (CD - 8.3% and 5.0%, UC - 1.1% and 4.2% in outpatient and inpatient practice, respectively). Based on the neural network analysis of the use of glucocorticoids and/or immunosuppressants in the treatment of IBD, the heterogeneity of therapeutic approaches between outpatient and polyclinic institutions was revealed: the patient’s belonging to a particular medical institution for patients with UC was of paramount importance compared to the severity of the disease, the characteristics of gastrointestinal lesions and other factors for making a decision on the appointment of glucocorticoids and/or immunosuppressants, and for patients with CD was second in degree of influence only to the severity of the course of the disease. Conclusion. Features of the treatment of IBD in St. Petersburg, Russia in routine clinical practice are characterized by the predominance of the use of various forms of 5-aminosalicylic acid in the treatment of both UC and CD, the relatively rare use of immunosuppressants in outpatient management, various approaches of outpatient medical institutions to the appointment of glucocorticoids and/or immunosuppressants. Optimization of therapy of patients with IBD within the framework of routine practice is possible through educational activities aimed at improving the practical knowledge in the field of IBD of gastroenterologists, therapists and general practitioners, as well as through the creation of a regional register of IBD patients.

inflammatory bowel diseases, Crohn’s disease, ulcerative colitis, treatment, 5-aminolycillic acid, immunosuppressors, corticosteroids, St. Petersburg

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