Treatment Persistence in Inflammatory Bowel Disease

Abstract

Introduction: Medication persistence provides real-world evidence on treatment effectiveness. Persistence of therapies in ulcerative colitis (UC)and Crohn's disease (CD) will provide surrogate markers of the effects of co-therapies. Methods: Two studies were conducted to investigate the persistence of biological medications in the treatment of UC and CD. The first study was a prospective national-population-based data on treatment persistence for adalimumab (ADA), infliximab (IFX), vedolizumab (VED) and ustekinumab (UST) for CD and UC were analysed from the Australian Pharmaceutical Benefits Scheme (PBS) using Kaplan-Meier analysis and Cox proportional hazards models. The second study was a meta-analysis of observational studies assessing advanced therapies' persistence in UC and CD. Results: The prospective Australian study included 2,499 patients (8,219 person-years of follow-up), and showed CD patients were 44% less likely to discontinue UST than anti-TNF agents (HR: 0.56, 95%CI: 0.42-0.76, P<0.001). 1-year CD persistence was UST: 80.0%, VED: 73.5%, IFX: 68.1%, ADA: 64.2% (P=0.01). Patients with moderate-severe UC were 40% less likely to discontinue VED than anti-TNF agents (HR: 0.60, 95%CI: 0.46-0.79, P<0.001). 1-year UC persistence was VED: 73.4%, IFX: 61.1%, ADA: 45.5% (P<0.001). Immunomodulator co-therapy did not significantly increase persistence in non-anti-TNF therapy (P>0.05). Thiopurines increased persistence of anti-TNF agents in CD and UC, while methotrexate co-therapy increased persistence of anti-TNF agents in CD. The meta-analysis demonstrated that among 63 observational studies, vedolizumab had the highest 1-year persistence in UC (73.8%, 95% CI: 70.0%-77.6%) and ustekinumab in CD (77.5%, 95% CI: 72.9%-82.1%).

Conclusion: The prospective Australian study and the meta-analaysis confirmed the superior persistence of ustekinumab and vedolizumab over TNF inhibitors.