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Biologic persistence rates suggest patient dissatisfaction in IBD therapy
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More than half of patients with inflammatory bowel disease either switched or discontinued their initial biologic therapy after one year, suggesting dissatisfaction in treatment or adverse disease outcomes, according to data published in Inflammatory Bowel Diseases.
Ellen M. Zimmermann, MD, of the division of gastroenterology, hepatology and nutrition at the University of Florida, and colleagues wrote that medication persistence is a simple way of analyzing how long a patient stays on a prescribed therapy, but it is useful as a tool to assess long-term therapeutic benefits and safety profile for medications.
“This assumes that patients persist in using the drug as long as it reduces the symptoms and prevents relapses until they experience intolerance or lose response to the medication,” they wrote. “This is very likely to be true for biologic medications for IBD because these drugs are indicated for long-term use to prevent disease progression.”
Researchers included 5,612 patients with Crohn’s disease and 3,533 patients with ulcerative colitis in their analysis of persistence among Remicade (infliximab, Janssen), Humira (adalimumab, AbbVie), Cimzia (certolizumab, UCB), Simponi (golimumab, Janssen) and Entyvio (vedolizumab, Takeda). They also evaluated for predictors of discontinuation and switching.
Investigators found that less than half of the patients in each cohort (48.48% in CD; 44.78% in UC) continued using their initial biologic treatment after one year. In the first year of treatment, adalimumab had the highest persistence and lowest switching rates in terms of median survival time for both CD (1.04 years) and UC (0.84 years). In the years following, patients taking infliximab were the most likely to persist using their biologic.
Patients receiving combination therapy with immunomodulators had a lower risk for discontinuation, particularly when immunomodulator therapy was initiated more than 30 days before the biologic (HR = 0.22; 95% CI, 0.16–0.32). Researchers determined that infection and hospitalization were both major predictors of noncompliance.
“The reasons for nonpersistence are likely to be worsening disease activity, or complications such as infection; age, gender, and geographic reasons also may exist,” Zimmermann and colleagues wrote. “Initiating immunomodulatory therapy before biologics will increase the persistence of biologic treatment.” – by Alex Young
Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures prior to publication.
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