Initial choice of biologic may affect persistence of therapy in IBD
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Among patients with inflammatory bowel disease who received at least two biologic therapies, discontinuation of treatment appeared to vary based on initial treatment choice, according to data presented at the ACG Annual Scientific Meeting.
“Decisions about choice of biologic for treatment of moderate to severe Crohn’s disease and ulcerative colitis are complex, owing to limited data on the comparative effectiveness of treatments,” Noa Krugliak Cleveland, MD, gastroenterology and advanced IBD fellow at the University of Chicago Medicine, said during a virtual poster presentation. “However, choice of initial biologic therapy is important because it may influence subsequent lines of therapy and clinical outcomes of patients.”
For the ROTARY-1 study, Cleveland and colleagues evaluated data from the Optum Clinical Database on adults with Crohn’s disease or ulcerative colitis who received at least two sequential biologic therapies and initiated therapy between Jan. 1, 2013, and Feb. 29, 2020. They then compared persistence of each line of biologic therapy across various treatment sequences.
The researchers defined persistence of therapy as treatment initiation until discontinuation with a gap of 60 days or more for adalimumab and 120 days or more for infliximab, vedolizumab (Entyvio, Takeda) and ustekinumab (Stelara, Janssen), according to the poster.
In the study, 22.1% of the 13,641 patients with Crohn’s disease and 23.1% of the 7,109 patients with ulcerative colitis who treated with a first-line biologic therapy subsequently received a second-line biologic therapy. For patients with Crohn’s disease, the most common treatment sequences were adalimumab to infliximab, adalimumab to vedolizumab and infliximab to adalimumab, whereas for patients with ulcerative colitis, the most common treatment sequences were adalimumab to vedolizumab, infliximab to vedolizumab and adalimumab to infliximab.
In patients with Crohn’s disease, the rates of discontinuation or switching with vedolizumab, infliximab and ustekinumab were 39.4%, 34.6% and 1.7% lower than the rate of discontinuation or switching with adalimumab, respectively, when used as first-line biologic therapy. When used as second-line biologics, the rates of discontinuation with vedolizumab, ustekinumab and infliximab were 47.2%, 45.3% and 40% lower than with adalimumab, respectively.
In patients with ulcerative colitis, the rates of discontinuation with infliximab and vedolizumab were 34.3% and 30.8% lower than with adalimumab, respectively, when used as first-line biologic therapy. When used as second-line biologics, the rates of discontinuation with vedolizumab, ustekinumab and infliximab were 56.5%, 45.6% and 43% lower than with adalimumab, respectively.
“We demonstrated that for both Crohn’s disease and ulcerative colitis, there were notable differences in persistence between therapies, favoring vedolizumab, infliximab and ustekinumab,” Krugliak Cleveland said. “We believe that the findings of this study may inform clinicians’ choice of treatment and positioning of biologic therapies in IBD.”
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Krugliak Cleveland N, et al. Poster: Persistence of first and second lines of biologic treatment across different treatment sequences in patients with inflammatory bowel disease receiving at least two biologics: Findings from ROTARY-1. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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