Biologic therapy for inflammatory bowel disease: Real-world comparative effectiveness and impact of drug sequencing in 13,222 patients within the UK IBD BioResource

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; Parkes, Miles; Raine, Tim

Abstract

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.

Citation

Kapizioni, C., Desoki, R., Lam, D., Balendran, K., Al-Sulais, E., Subramanian, S., …Raine, T. (2024). Biologic therapy for inflammatory bowel disease: Real-world comparative effectiveness and impact of drug sequencing in 13,222 patients within the UK IBD BioResource. Journal of Crohn's and Colitis, 18(6), 790-800. https://doi.org/10.1093/ecco-jcc/jjad203

• Journal Article Type: Article
• Acceptance Date: Nov 21, 2023
• Online Publication Date: Dec 2, 2023
• Publication Date: 2024-06
• Deposit Date: Nov 21, 2023
• Publicly Available Date: Dec 3, 2024
• Journal: Journal of Crohn's and Colitis
• Electronic ISSN: 1876-4479
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: 6
• Pages: 790-800
• DOI: https://doi.org/10.1093/ecco-jcc/jjad203
• Keywords: biologic therapysequencing, real-world effectiveness, Crohn’s disease, ulcerative colitis
• Public URL: https://nottingham-repository.worktribe.com/output/27589846
• Publisher URL: https://academic.oup.com/ecco-jcc/article/18/6/790/7458039