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

J Crohns Colitis. 2023 Dec 2:jjad203. doi: 10.1093/ecco-jcc/jjad203. Online ahead of print.


Christina Kapizioni 1 2Rofaida Desoki 1 3Danielle Lam 1 4Karthiha Balendran 1 5Eman Al-Sulais 1 6Sreedhar Subramanian 1Joanna E Rimmer 7Juan De La Revilla Negro 1Holly Pavey 8 9Laetitia Pele 10 11Johanne Brooks 12 13Gordon W Moran 14Peter M Irving 15 16Jimmy K Limdi 17 18Christopher A Lamb 19 20UK IBD BioResource InvestigatorsMiles Parkes 1Tim Raine 1


Author information

1Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

2Department of Gastroenterology, Attikon University Hospital, Athens, Greece.

3Department of Genetics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

4Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia.

5Department of Clinical Medicine, University of Jaffna, Sri Lanka.

6King Fahad Specialist Hospital, Dammam, Saudi Arabia.

7Academic Department of Military Medicine, Royal Centre for Defence Medicine, Medical Directorate, Joint Medical Command, Birmingham Research Park, Birmingham, UK.

8Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK.

9Institute of Health Economics, Medical University Innsbruck, Innsbruck, Austria.

10Department of Medicine, University of Cambridge, UK.

11IBD BioResource, NIHR BioResource, Cambridge, UK.

12Department of Clinical Pharmacology and Biological Sciences, University of Hertfordshire, Hatfield, UK.

13Gastroenterology Department, Lister Hospital, Stevenage, UK.

14University of Nottingham, NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK.

15Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

16School of Immunology and Microbial Sciences, King's College London, London, UK.

17IBD Section- Northern Care Alliance NHS Foundation Trust, Manchester, UK.

18Faculty of Biology, Medicine & Health,University of Manchester.

19Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK.

20Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.


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.

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