Biologic therapy for inflammatory bowel disease : Real-world comparative effectiveness and impact of drug sequencing in 13,222 patients within the UK IBD BioResource
© The Author(s) 2023. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation..
BACKGROUND AND AIMS: To compare effectiveness of different biologic therapies and sequences in patients with Inflammatory Bowel Disease (IBD) using real-world data from a large cohort with long exposure.
METHODS: Demographic, disease, treatment and outcome data were retrieved for patients in the UK IBD BioResource. Effectiveness of treatment was based on persistence free of discontinuation or failure, analysed by Kaplan-Meier survival analysis with inverse probability of treatment weighting to adjust for differences between groups.
RESULTS: 13,222 evaluable patients received at least one biologic. In ulcerative colitis (UC) first line vedolizumab (VDZ) demonstrated superior effectiveness over five years compared to anti-TNF agents (p=0.006). VDZ was superior to both infliximab (IFX) and adalimumab (ADA) after ADA and IFX failure respectively (p<0.001 and p<0.001). Anti-TNF therapy showed similar effectiveness when used first-line, or after failure of VDZ. In Crohn's disease (CD) we found significant differences between first line treatments over ten years (p=0.045), with superior effectiveness of IFX compared to ADA in perianal CD. Non-anti-TNF biologics were superior to a second anti-TNF after first line anti-TNF failure in CD (p=0.035). Patients with UC or CD experiencing TNF-failure due to delayed loss of response or intolerance had superior outcomes when switching to a non-anti-TNF biologic, rather than a second anti-TNF.
CONCLUSIONS: We provide real-world evidence to guide biologic selection and sequencing in a range of common scenarios. Our findings challenge current guidelines regarding drug selection after loss of response to first anti-TNF.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
Journal of Crohn's & colitis - (2023) vom: 02. Dez. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kapizioni, Christina [VerfasserIn] |
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| Links: |
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| Themen: |
Biologic therapysequencing |
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| Anmerkungen: |
Date Revised 20.03.2024 published: Print-Electronic CommentIn: J Crohns Colitis. 2024 Jan 17;:. - PMID 38233095 Citation Status Publisher |
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| doi: |
10.1093/ecco-jcc/jjad203 |
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| funding: |
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| 100 | 1 | |a Kapizioni, Christina |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Biologic therapy for inflammatory bowel disease |b Real-world comparative effectiveness and impact of drug sequencing in 13,222 patients within the UK IBD BioResource |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Crohns Colitis. 2024 Jan 17;:. - PMID 38233095 | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. | ||
| 520 | |a BACKGROUND AND AIMS: To compare effectiveness of different biologic therapies and sequences in patients with Inflammatory Bowel Disease (IBD) using real-world data from a large cohort with long exposure | ||
| 520 | |a METHODS: Demographic, disease, treatment and outcome data were retrieved for patients in the UK IBD BioResource. Effectiveness of treatment was based on persistence free of discontinuation or failure, analysed by Kaplan-Meier survival analysis with inverse probability of treatment weighting to adjust for differences between groups | ||
| 520 | |a RESULTS: 13,222 evaluable patients received at least one biologic. In ulcerative colitis (UC) first line vedolizumab (VDZ) demonstrated superior effectiveness over five years compared to anti-TNF agents (p=0.006). VDZ was superior to both infliximab (IFX) and adalimumab (ADA) after ADA and IFX failure respectively (p<0.001 and p<0.001). Anti-TNF therapy showed similar effectiveness when used first-line, or after failure of VDZ. In Crohn's disease (CD) we found significant differences between first line treatments over ten years (p=0.045), with superior effectiveness of IFX compared to ADA in perianal CD. Non-anti-TNF biologics were superior to a second anti-TNF after first line anti-TNF failure in CD (p=0.035). Patients with UC or CD experiencing TNF-failure due to delayed loss of response or intolerance had superior outcomes when switching to a non-anti-TNF biologic, rather than a second anti-TNF | ||
| 520 | |a CONCLUSIONS: We provide real-world evidence to guide biologic selection and sequencing in a range of common scenarios. Our findings challenge current guidelines regarding drug selection after loss of response to first anti-TNF | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Balendran, Karthiha |e verfasserin |4 aut | |
| 700 | 1 | |a Al-Sulais, Eman |e verfasserin |4 aut | |
| 700 | 1 | |a Subramanian, Sreedhar |e verfasserin |4 aut | |
| 700 | 1 | |a Rimmer, Joanna E |e verfasserin |4 aut | |
| 700 | 1 | |a De La Revilla Negro, Juan |e verfasserin |4 aut | |
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