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Early patient status predicts long-term outcomes of biologic treatment for Crohn’s disease

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WASHINGTON — Patient status after 14 weeks of biologic treatment helped to predict remission and other outcomes for patients with Crohn’s disease, according to research presented at Digestive Disease Week.

Tariq Ahmad, MD, of IBD Pharmacogenetics at Exeter University in the United Kingdom, and colleagues analyzed data from the PANTS study, a three-year prospective observational study in the U.K. designed to determine the mechanisms that underlie primary non-response, loss of response and adverse drug reactions to adalimumab, Remicade (infliximab, Janssen) and CT-P13, an infliximab biosimilar.

“This is the largest real-world study of anti-TNF therapy in Crohn’s disease,” Ahmad said during his presentation.

The study comprised 1,601 patients recruited from 118 U.K. health care centers with active CD and no prior exposure to anti-TNF therapy. Overall, 751 patients received infliximab (47%), 200 received CT-P13 (12%), and 650 received adalimumab (41%).

Primary non-response was 21% for both infliximab and CT-P13 and 26% for adalimumab at weeks 12 to 14. Factors associated with primary non-response at this stage included BMI, immunomodulator use and low drug volume. Remission at week 54 was 40% for both infliximab and CT-P13 and 34% for adalimumab.

“Concomitant use of immunomodulators was associated with better remission rate for infliximab but not for adalimumab at one year,” Ahmad said.

Clinical remission status at week 14 predicted patient outcomes at week 54. Patients with remission status at week 14 were more likely to achieve remission at one year, while few patients with primary non-response at week 14 eventually achieved remission, Ahmad said.

Additionally, BMI at baseline, as well as drug concentration at week 14 was associated with patient outcomes at one year.

“We’ve shown that drug level is a major determinant of primary non-response at weeks 12 to 14 and also non-remission at week 54,” Ahmad said. – by Alex Young

Reference:

Kennedy NA, et al. Abstract 159. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Ahmad reports financial relationships with AbbVie, Celltrion, Janssen, Pfizer, Takeda and MSD.