Dig Liver Dis. 2021 Jul 6;S1590-8658(21)00319-4. doi: 10.1016/j.dld.2021.06.005.Online ahead of print.

G Bastida ¹, I Marín-Jiménez ², A Forés ³, E García-Planella ⁴, F Argüelles-Arias ⁵, I Tagarro ⁶, A Fernandez-Nistal ⁶, C Montoto ⁶, J Aparicio ⁶, M Aguas ⁷, J Santos-Fernández ⁸, M M Boscá-Watts ⁹, R Ferreiro-Iglesias ¹⁰, O Merino ¹¹, X Aldeguer ¹², X Cortés ¹³, B Sicilia ¹⁴, F Mesonero ¹⁵, M Barreiro-de Acosta ¹⁰

Author information

• ¹Department of Gastroenterology, Hospital La Fe, Valencia, Spain. Electronic address: guille.bastida@gmail.com.
• ²Department of Gastroenterology, Hospital Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
• ³Hospital General Universitario de Castellón, Castellón, Spain.
• ⁴Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
• ⁵Hospital Universitario Virgen Macarena, Sevilla, Spain.
• ⁶Takeda Farmacéutica España S.A., Madrid, Spain.
• ⁷Department of Gastroenterology, Hospital La Fe, Valencia, Spain.
• ⁸Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
• ⁹IBD Unit, Gastroenterology Department of the University Clinic Hospital of Valencia, Valencia, Spain.
• ¹⁰Department of Gastroenterology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
• ¹¹Department of Gastroenterology, Hospital Universitario Cruces, Bilbao, Spain.
• ¹²Department of Gastroenterology, Hospital Dr Josep Trueta, Girona, Spain.
• ¹³IBD Unit, Gastroenterology Section, Internal Medicine Hospital of Sagunto, Sagunto, Spain; University of Cardenal Herrera-CEU, Castellón, Spain.
• ¹⁴Hospital Universitario de Burgos, Burgos, Spain.
• ¹⁵Gastroenterology Department, Hospital Ramón y Cajal, Madrid, Spain.

Abstract

Background: Anti-TNFα represent one of the main treatment approaches for the management of inflammatory bowel diseases (IBD). Therefore,the evaluation of their treatment patterns over time provides valuable insights about the clinical value of therapies and associated costs.

Aims: To assess the treatment patterns with the first anti-TNFα in IBD.

Methods: Retrospective, observational study.

Results: 310 IBD patients were analyzed along a 5-year follow-up period. 56.2% of Crohn's disease (CD) patients started with adalimumab (ADA), while 43.8% started with infliximab (IFX). 12.9% of ulcerative colitis (UC) patients initiated with ADA, while 87.1% initiated with IFX. Treatment intensification was required in 28.9% of CD and 37.1% of UC patients. Median time to treatment intensification was shorter in UC than in CD (5.3 vs. 14.3 months; p = 0.028). Treatment discontinuation due to reasons other than remission were observed in 40.7% of CD and 40.5% of UC patients, although, in UC patients there was a trend to lower discontinuation rates with IFX (36.6%) than with ADA (66.7%). Loss of response accounted for approximately one-third of discontinuations, in both CD and UC.

Conclusions: Around one-third of IBD biologic-naive patients treated with an anti-TNFα required treatment intensification (earlier in UC) and around 40% discontinued the anti-TNFα due to inappropriate disease control.