| Title: |
Biologic Therapy for Inflammatory Bowel Disease: Real-World Comparative Effectiveness and Impact of Drug Sequencing in 13 222 Patients within the UK IBD BioResource. |
| Authors: |
Kapizioni, Christina; Desoki, Rofaida; Lam, Danielle; Balendran, Karthiha; Al-Sulais, Eman; Subramanian, Sreedhar; Rimmer, Joanna E; De La Revilla Negro, Juan; Pavey, Holly; Pele, Laetitia; Brooks, Johanne; Moran, Gordon W; Irving, Peter M; Limdi, Jimmy K; Lamb, Christopher A; UK IBD BioResource Investigators; Parkes, Miles; Raine, Tim |
| Publisher Information: |
MRC Epidemiology Unit; Department of Public Health and Primary Care, Cardiovascular Epidemiology Unit; Department of Medicine; //doi.org/10.1093/ecco-jcc/jjad203; Oxford University Press (OUP) |
| Publication Year: |
2024 |
| Collection: |
Apollo - University of Cambridge Repository |
| Subject Terms: |
Crohn’s disease; biologic therapy; real-world effectiveness; sequencing; ulcerative colitis; Humans; Male; Female; Adalimumab; Antibodies; Monoclonal; Humanized; Infliximab; United Kingdom; Adult; Colitis; Ulcerative; Middle Aged; Gastrointestinal Agents; Crohn Disease; Tumor Necrosis Factor-alpha; Biological Products; Treatment Outcome; Biological Therapy; Inflammatory Bowel Diseases; Etanercept; Tumor Necrosis Factor Inhibitors |
| Description: |
BACKGROUND AND AIMS: This study compares the 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: In total, 13 222 evaluable patients received at least one biologic. In ulcerative colitis [UC] first-line vedolizumab [VDZ] demonstrated superior effectiveness over 5 years compared to anti-tumour necrosis factor [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 as first-line treatment, or after failure of VDZ. In Crohn's disease [CD] we found significant differences between first-line treatments over 10 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 treatment. |
| Document Type: |
article in journal/newspaper |
| File Description: |
Print; application/pdf |
| Language: |
English |
| Relation: |
https://www.repository.cam.ac.uk/handle/1810/393006 |
| Availability: |
https://www.repository.cam.ac.uk/handle/1810/393006 |
| Rights: |
Attribution 4.0 International ; https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.2DFFD1C3 |
| Database: |
BASE |