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THE ROAD TO AND SEQUENCE OF BIOLOGICAL THERAPY IN A POPULATION-BASED, EUROPEAN INCEPTION COHORT OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE -AN EPI-IBD COHORT STUDY

Mads Damsgaard Wewer 1, Riina Salupere 2, Hendrika Adriana Linda Kievit 3, Kari Rubek Nielsen 4, Jóngerð Midjord 4, Viktor Domislovic 5, Zeljko Krznaric 5, Natalia Pedersen 6, jens kjeldsen 7, Carl Eriksson 8, Jonas Halfvarson 8, Alison Talbot 9, Shaji Sebastian 9, Eugen-Adrian Goldis 10, Ravi Misra 11, Naila Arebi 11, Tuire Meri Ilus 12, Pia Oksanen 13, Anders Neumann 14, Vibeke Andersen 15, Alexandros Skamnelos 16, Konstantinos H. Katsanos 16, Iulian Negru 17, Valentina Platon 17, Svetlana Turcan 17, Kelly Conti 18, Pierre Ellul 18, Juozas Kupcinskas 19, Gediminas Kiudelis 19, Clara Yzet 20, Mathurin Fumery 20, Ioannis Kaimakliotis 21, Greta Lorenzon 22, Renata D'Incà 22, Vicente Hernandez Ramirez 23, Alberto Fernández Villaverde 24, Ebbe Langholz 25, Pia Munkholm 26, Johan Burisch 1

Affiliations

1 Hvidovre University Hospital, Hvidovre, Denmark|||Hvidovre Unversity Hospital, Hvidovre, Denmark

2 Tartu University Hospital, Tartu, Estonia

3 Herning Central Hospital, Herning, Denmark

4 National Hospital of the Faroe Islands, Torshavn, Faroe Islands

5 University Hospital Centre Zagreb, Zagreb, Croatia

6 Slagelse Regional Hospital, Slagelse, Denmark

7 Odense University Hospital, Odense, Denmark

8 Örebro University, Örebro, Sweden

9 Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom

10 University of Medicine ‘Victor Babes’, Timisoara, Romania

11 St. Marks Hospital, London, United Kingdom

12 Tampere University Hospital, Tampere, Finland

13 Tampere University Hospital, Tampere, Finland|||Tampere University, Tampere, Finland

14 Viborg Hospital, Viborg, Denmark

15 University Hospital of Southern Denmark, Aabenraa, Denmark|||University of Southern Denmark, Odense, Denmark, Odense, Denmark|||University of Southern Denmark, Odense, Denmark, Odense, Denmark

16 University Hospital and University of Ioannina, Ioannina, Greece

17 Nicolae Testemitanu State University of Medicine and Pharmacy of Moldova, Chisinau, Moldova, Republic of

18 Mater Dei Hospital, Bugibba, Malta

19 Lithuanian University of Health Sciences, Kaunas, Lithuania

20 Amiens University Hospital, Amiens, France

21 American Gastroenterology Center, Nicosia, Cyprus

22 University of Padua, Padua, Italy

23 Xerencia Xestion Integrada de Vigo, SERGAS, Vigo, Spain|||Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain, VigoSpain, Spain

24 Ribera-POVISA Hospital, Vigo, Spain, Vigo, Spain

25 University Hospital Copenhagen – Herlev Hospital, Herlev, Herlev, Denmark

26 University Hospital Copenhagen – North Zealand Hospital, Hillerød, Denmark

Summary

AI Generated

In a prospective European population-based cohort of 1,390 IBD patients diagnosed in 2010-2011 and followed for a median of 10.7 years, 34% of Crohn's disease and 15% of ulcerative colitis patients received biological therapy.

Biological therapy was initiated at a median of 1.0 year after Crohn's disease diagnosis and 2.7 years after ulcerative colitis diagnosis, with 16.8% and 3.8% respectively starting within the first year.
Infliximab was the most common first-line biological therapy in 74% of patients, followed by adalimumab in 22%.
About one-third of patients who started biologics received at least two different biological drugs during follow-up.
Only 63% of Crohn's disease patients and 51% of ulcerative colitis patients received concomitant immunomodulators with their first biological therapy.
Most patients were exposed to systemic steroids prior to biological therapy, with many receiving multiple courses, and the most common pre-biologic treatment sequences involved steroids and immunomodulators.

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Abstract

Introduction

The Epi-IBD cohort is a prospective European population-based cohort of 1,390 patients diagnosed with inflammatory bowel disease (IBD) in 2010 and 2011 according to Copenhagen criteria. Of these, 482 were diagnosed with Crohn’s Disease (CD), 817 with ulcerative colitis (UC) and 91 with IBD unclassified (IBDU). The Epi-IBD cohort was established to examine differences in incidence, treatment strategies, disease course and prognosis among IBD patients in Eastern and Western Europe.

Aims & Methods

This study aims to describe the use of biological therapy as well as the treatment prior to biological therapy. IBD patients were followed prospectively from the time of diagnosis until the 31^st December 2020, death, emigration or loss of follow-up. Clinical data on surgery, hospitalizations, and medical treatment, were captured throughout the follow-up period and entered into a validated web-database, www.epi-ibd.org.

Results

During a median follow-up period of 10.7 (interquartile range (IQR), 10.0-11.4) years, 34% (N=165/482) of CD and 15% (N=122/817) of UC patients were started on biological therapy. Biological therapy was initiated within the first year after diagnosis in 16.8% (N=81/482) of all CD and 3.8% (N=31/817) of all UC patients. In median biological therapy was started at 1.0 year (IQR, 0.3-3.1) and 2.7 years (IQR, 1.6-4.0) after CD and UC diagnosis, respectively. First-line biological therapy was infliximab in 74% (N=213/287) and adalimumab in 22% (N=64/287) of the patients. The remaing (N=10/287) received either Golimumab, Vedolizumab, Ustekinumab or were part of a trial/unknown. The sequences of biological therapies are displayed in Sankey diagrams, Figures 1 and 2. Herein illustrated is that 34% (N=56/165) CD and 34% (N=41/122) UC received at least two different biological drugs. Immunomodulators were initiated simultaneously to the first biological therapy in 19% (N=31/165) of CD patients and in 9% (N=11/122) of UC patients. Overall 63% (N=104/165) CD and 51% (N=62/122) UC patients were receiving concomittant immunomodulators with the first biological therapy.
The sequences of therapy leading up to biological therapy are displayed in Sankey diagrams, Figures 3 and 4. Herein illustrated is that the most common sequence of treatment before the first biological therapy for CD was 1) Steroids, 2) Immunomodulators (21%, N=34/165), and for UC was 1) 5-aminosalicylic-acid (5ASA), 2) Steroids, 3) Immunomodulators (39%, N=48/122). Prior to the first biological therapy one, two and three or more courses of systemic steroid were used in 41%, 28% and 17% (N=67, 47 and 28) of CD patients and 43%, 24% and 26% (N=52, 29 and 32) of UC patients. In 14% (N=23/165) and 7% (N=9/122) of CD and UC patients, systemic steroids were not used prior to first biological therapy. In patients having immunomodulators prior to biological therapy, these were administered for a median of 0.5 (IQR, 0.1-1.9) years and 1.1 (IQR, 0.2-3,2) years in CD and UC, respectively. For 5ASA this was 0.8 (IQR, 0.2-1.5) years for CD and 2.2 (IQR, 0.8-4.3) years for UC.

Conclusion

In this multicenter European population-based cohort, different prescribing patterns for biologics emerge: 34% of CD and 15% of UC patients received biologics within 10 years after diagnosis. Infliximab was the most common first-line biological therapy. Only about half of the patients received concomitant immunomodulators. Prior to the first biological therapy, most patients were exposed to systemic steroids and many to repeated courses.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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