Inflamm Bowel Dis. 2024 Apr 5:izae067. doi: 10.1093/ibd/izae067. Online ahead of print.

Ohad Atia ¹, Chagit Friss ¹, Gili Focht ¹, Ramit Magen Rimon ², Natan Ledderman ³, Shira Greenfeld ⁴, Amir Ben-Tov ⁴, Yiska Loewenberg Weisband ⁵, Eran Matz ⁶, Yuri Gorelik ⁷, Yehuda Chowers ⁷, Iris Dotan ⁸, Dan Turner ¹

Author information

¹Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.

²Pediatric Gastroenterology & Nutrition Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus and the Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.

³Meuhedet Health Services, Tel-Aviv, Israel.

⁴Kahn-Sagol-Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

⁵Clalit Health Services, Clalit Research Institute, Tel-Aviv, Israel.

⁶Leumit Health Services, Tel-Aviv, Israel.

⁷Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology and the Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel.

⁸Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Abstract

Background: In this nationwide study, our objective was to compare the durability of first-line biologics in ulcerative colitis (UC), categorized into monotherapy and combotherapy with immunomodulators.

Methods: We utilized data from the nationwide epi-IIRN cohort from 2005 to 2020. Durability was defined as consistent treatment without surgery. Comparisons were based on stringent propensity score-matching.

Results: We included 15 111 patients with UC, of whom 2322 (15%) received biologics, with a median follow-up of 7.0 years (interquartile range, 3.8-11.0). The durability rate was similar between pediatric-onset and adults after 1 and 5 years from initiation of treatment (72% and 43% vs 71% and 43%, respectively; P = .8). Durability of adalimumab vs infliximab after 1 or 5 years was similar, whether prescribed as monotherapy (65%/46% vs 63%/33%, respectively; n = 182 matched pairs, P = .3) or combotherapy (78%/56% vs 91%/58%, respectively; n = 46 matched pairs, P = .4). Durability of infliximab was higher as combotherapy (85%/50%) vs monotherapy (69%/42%; n = 174 matched pairs, P = .007), while it was similar for adalimumab (80%/52% vs 74%/52%; n = 53 matched pairs, P = .4). The durability rate was similar for vedolizumab monotherapy (77%/56%) compared with adalimumab monotherapy (69%/52%; n = 125 matched patients, P = .1), and infliximab monotherapy (73%/55% vs 62%/44%; n = 78 matched patients, P = .1). However, combotherapy of antitumor necrosis factors (TNFs) had longer durability than vedolizumab (85%/50% vs 75%/43%, respectively; n = 131 matched pairs, P = .02).

Conclusion: After 5 years of treatment, 43% of the patients with UC sustained their first biologic, with similar durability in pediatric and adult-onset onset disease. Anti-TNFs had similar durability to vedolizumab and superior durability when prescribed as combotherapy.