OP26 Impact of telemonitoring on the management of Inflammatory Bowel Disease in Spain: a multicenter TECCU clinical trial

Abstract

Background: Telemedicine is not consistently superior to standard care in the management of inflammatory bowel disease (IBD). Noninferiority is an acceptable outcome if telemedicine improves the efficacy and efficiency of care. Owing to the positive results of the TECCU app (Telemonitoring of Crohn's Disease [CD] and Ulcerative Colitis [Au]) in a pilot trial1, we aimed to evaluate the time in remission and quality of life (QoL) of IBD patients controlled by telemonitoring (G‐ TECCU), compared to standard care (G‐Control) after 12 weeks 1Del Hoyo J et al. J Med Internet Res. 2018;20(11):e11602 Methods: A 2‐arm randomized multicenter study with a non‐inferiority design was performed in 29 IBD centers in Spain. Adult IBD patients who initiated therapy with immunosuppressant or biological agents for disease activity were included. Exclusion criteria were: Patients with ileorectal/ileo‐pouch anal anastomosis, stoma, active perianal disease no Internet access. Time in remission was evaluated with Harvey‐ Bradshaw/Walmsley indexes (according to CD]/UC, respectively), fecal calprotectin (FC) and reactive C protein (RCP). QoL was assessed with IBDQ‐9, medication adherence with Morisky‐Green index and patient satisfaction with a questionnaire derived from CSQ‐8 Results: We included 157 patients, and 126 were analyzed after 12 weeks of follow‐up. The demographic and clinical variables are listed in Table 1. The time in remission was not inferior in patients who used the TECCU app (mean 4.2 weeks [SD 3.8]) compared with patients who received standard care (mean 4.2 weeks [SD 3.2]; difference 0.03 [95%CI ‐1.21 to 1.27]; p=0.017) (Figure 1). In patients with UC, disease activity improved significantly in both TECCU (mean SCCAI improvement ‐3.60 [SD 3.25]; p= 0.001) and standard care groups (‐3.89 [SD 4.56]; p=0.001;). In patients with CD, clinical activity also improved significantly in both groups (mean Harvey‐Bradshaw improvement ‐1.65 [SD 2.51]; p=0.001 in TECCU; ‐2.24 [SD 4.15]; p=0.001 in standard care group). Similarly, FC and CRP values improved significantly in both groups (Figure 2). Considering QoL, the IBDQ‐9 score improved significantly in TECCU (mean 11.29 [SD15.8]; p<0.001) and standard care groups (16.59 [SD 22.1]; p<0.001). Medication adherence improved significantly in TECCU group and it was superior compared with standard care (Figure 3). Patient satisfaction was superior to 90% in both groups at week 12 Conclusion: In IBD patients who initiate biological agents or immunomodulators TECCU app is not inferior to standard care to maintain remission in the short‐term. Telemonitoring with TECCU app associated a higher improvement in medication adherence and an increase in QoL. Long‐term results are needed to confirm it.