Anava Wren

Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015

BackgroundnOpioids are commonly prescribed for relief in inflammatory bowel disease (IBD). Emerging evidence suggests that adolescents and young adults are a vulnerable population at particular risk of becoming chronic opioid users and experiencing adverse effects.nnnObjectivesnThis study evaluates trends in the prevalence and persistence of chronic opioid therapy in adolescents and young adults with IBD in the United States.nnnMethodnA longitudinal retrospective cohort analysis was conducted with the Truven MarketScan Database from 2007 to 2015. Study subjects were 15-29 years old with ≥2 IBD diagnoses (Crohns: 555/K50; ulcerative colitis: 556/K51). Opioid therapy was identified with prescription claims within the Truven therapeutic class 60: opioid agonists. Persistence of opioid use was evaluated by survival analysis for patients who remained in the database for at least 3 years following index chronic opioid therapy use.nnnResultsnIn a cohort containing 93,668 patients, 18.2% received chronic opioid therapy. The annual prevalence of chronic opioid therapy increased from 9.3% in 2007 to 10.8% in 2015 (P < 0.01), peaking at 12.2% in 2011. Opioid prescriptions per patient per year were stable (approximately 5). Post hoc Poisson regression analyses demonstrated that the number of opioid pills dispensed per year increased with age and was higher among males. Among the 2503 patients receiving chronic opioid therapy and followed longitudinally, 30.5% were maintained on chronic opioid therapy for 2 years, and 5.3% for all 4 years.nnnConclusionnSustained chronic opioid use in adolescents and young adults with IBD is increasingly common, underscoring the need for screening and intervention for this vulnerable population.

Market share and costs of biologic therapies for inflammatory bowel disease in the USA

Real‐world data quantifying the costs of increasing use of biologics in inflammatory bowel disease (IBD) are unknown.

The relationship between holding back from communicating about breast concerns and anxiety in the year following breast biopsy

ABSTRACT Purpose: Evidence suggests open communication about breast cancer concerns promotes psychological adjustment, while holding back can lead to negative outcomes. Little is known about the relationship between communication and distress following breast biopsy. Design/ Sample: Women (N = 128) were assessed at the time of breast biopsy and again one week and three, six, and 12 months post-result. Methods: Linear mixed modeling examined relationships between holding back and anxiety for women with benign results (n = 94) or DCIS/invasive disease (n = 34) following breast biopsy. Findings: Anxiety increased among women with a benign result engaging in high but not low or average levels of holding back. Holding back was positively associated with anxiety post-result in breast cancer survivors, with anxiety decreasing over time. Conclusions/ Implications: Interventions to enhance communication are warranted, and knowledge of the differences among women with benign results and/or DCIS/invasive disease may allow for the development of tailored interventions.

Depression and Healthcare Utilization in Patients with Inflammatory Bowel Disease

BackgroundnDepression frequently co-occurs in patients with inflammatory bowel disease [IBD] and is a driver in health care costs and use.nnnAimnThis study examined the associations between depression and total health care costs, emergency department [ED] visits, computed tomography [CT] during ED/inpatient visits, and IBD-related surgery among IBD patients.nnnMethodsnOur sample included 331772 IBD patients from a national administrative claims database [Truven Health MarketScan® Database]. Gamma and Poisson regression analyses assessed differences related to depression, controlling for key variables.nnnResultsnApproximately 16% of the IBD cohort was classified as having depression. Depression was associated with a

Yoga as adjunct therapy for adolescents with inflammatory bowel disease: A pilot clinical trial

17,706 (95% confidence interval [CI] [

A group CBT-yoga protocol targeting pain-related and internalizing symptoms in youth.

16,892, 18,521]) increase in mean annual IBD-related health care costs and an increased incidence of ED visits (adjusted incidence rate ratio [aIRR] of 1.5; 95% CI [1.5, 1.6]). Among patients who had one or more ED/inpatient visits, depression was associated with an increased probability of receiving repeated CT [one to four scans, adjusted odds ratio [aOR] of 1.6; 95% CI [1.5, 1.7]; five or more scans, aOR of 4.6; 95% CI [2.9, 7.3]) and increased odds of undergoing an IBD-related surgery (aOR of 1.2; 95% CI [1.1, 1.2]). Secondary analysis with a paediatric subsample revealed that approximately 12% of this cohort was classified as having depression, and depression was associated with increased costs and incidence rates of ED visits and CT, but not of IBD-related surgery.nnnConclusionsnQuantifiable differences in health care costs and patterns of use exist among patients with IBD and depression. Integration of mental health services within IBD care may improve overall health outcomes and costs of care.

Risk of post-operative surgical site infections after vedolizumab vs anti-tumour necrosis factor therapy: a propensity score matching analysis in inflammatory bowel disease

OBJECTIVESnTo determine whether utilizing yoga as an adjunctive therapy to the medical standard of care for adolescents with inflammatory bowel disease (IBD) is: (1) feasible and acceptable, (2) effective in reducing disease severity, intestinal inflammation and improving wellness.nnnDESIGNnProspective, non-randomized, 8-week pilot study for adolescents with a diagnosis of IBD. Feasibility and acceptability of the intervention were assessed weekly and post-intervention via surveys and a focus group (week 8). Disease severity, intestinal inflammation, and wellness measures were assessed at baseline and post-intervention (week 8).nnnINTERVENTIONnOver the 8-week study period, patients were assigned three 60-minute, in-person yoga classes at weeks 1, 3 and 8, and three 30-minute, online yoga videos per week.nnnMAIN OUTCOME MEASURESnPrimary outcome measures were feasibility and acceptability. Secondary outcome measures assessed preliminary clinical efficacy by examining pre- and post-intervention change in disease severity (PUCAI), intestinal inflammation (fecal calprotectin), and six wellness measures (PROMIS-37).nnnRESULTSnNine adolescents with IBD participated. Eight participated in one or more yoga videos per week and all nine attended at least two in-person yoga classes. Focus group themes revealed that the intervention was well liked, with all participants reporting reduced stress, improved emotional self-awareness, and increased ability to identify and manage the physical symptoms of IBD. Participants had difficulty, however, completing the yoga videos due to time limitations and competing priorities. We lacked power to detect any statistically significant changes in PUCAI, calprotectin, or any of the six PROMIS-37 domains.nnnCONCLUSIONSnA combination of in-person instructor led yoga with video-based yoga is a feasible and acceptable adjunct therapy for adolescents with IBD. Participants reported reduced stress and improved ability to identify and manage physical symptoms. A larger, randomized controlled trial is necessary to determine if the yoga protocol results in clinically and statistically significant improvements in inflammatory biomarkers and patient reported outcomes.

22 PERSISTENT OPIOID USE AND HEALTHCARE UTILIZATION AMONG ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE IN THE UNITED STATES

There is a high prevalence of pain-related somatic symptoms among children with internalizing disorders. Despite the documented comorbidity between somatic and internalizing symptoms in youth, there are limited empirically supported interventions that simultaneously target these issues. In light of this, the current pilot study investigated the feasibility and preliminary efficacy of a novel 12-week manualized group-based CBT-yoga protocol, which aimed to target co-occurring physical and internalizing symptoms in a sample of youth. Twenty-eight children between the ages of 10 and 12 years old who had clinically relevant internalizing symptoms and pain-related somatic symptoms were enrolled in the 12-week intervention protocol. Attendance rates and parent and child responses on social validity scales provided measures of feasibility. Preliminary efficacy was examined through a series of paired sample t tests, measuring changes in internalizing and somatic symptoms, and pain-related coping following the intervention. Results suggest strong levels of child- and parent-rated feasibility. Preliminary data also reveal improvements in internalizing and somatic symptoms following the intervention, in addition to improvements in pain-related coping. These findings provide initial support for the feasibility and acceptance of an integrative group-based intervention combining cognitive–behavioral strategies with yogic practices.

Sa1710 - Risk of Postoperative Surgical Site Infections after Vedolizumab vs Anti-TNF Therapy: A Propensity-Matched Cohort Analysis

Perioperative vedolizumab (VDZ) and anti‐tumour necrosis factor (TNFi) therapies are implicated in causing post‐operative complications in inflammatory bowel disease (IBD).