Details

Autor(en) / Beteiligte

• Ahmad, Tariq
• Kennedy, Nicholas A.
• Louis, Edouard
• Kligys, Kristina
• Finney-Hayward, Tricia
• Raine, Tim

Titel

An Analysis of Latest Data on Sequential Use of Biologic Therapies in Patients with Inflammatory Bowel Disorder: A Systematic Literature Review: 715

Ist Teil von

• The American journal of gastroenterology, 2018-10, Vol.113 (Supplement), p.S401-S402

Ort / Verlag

New York: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins

Erscheinungsjahr

2018

Beschreibungen/Notizen

• Introduction: Increased availability of biologic treatments for inflammatory bowel disease (IBD: ulcerative colitis, UC and Crohn's disease, CD), along with significant rates of primary and secondary loss of response, means clinicians increasingly face decisions regarding biologic drug sequencing. Biologic response rates are typically lower in patients for whom earlier biologic treatment has failed, although the evidence-base in this regard is incomplete. Methods: A systematic literature search of PubMed (Jan 2000 - May 2018) and key gastroenterology congresses (2013 - May 2018) was undertaken to identify studies reporting efficacy outcomes associated with sequential biologic drug use in patients with IBD. Study quality was assessed using the Oxford Centre for Evidence-based Medicine levels of evidence. Aggregate response rates (total number of responders/total number of participants) were derived for key biologic sequences, from those studies with a clear definition of response evaluated over > 12 weeks' treatment. Results: Data were extracted from 131 publications (Figure 1). The highest quality (level 1) was assigned to only 23% of the studies; most studies (75%) were classified as level 2, with the remainder unassigned. The biologic sequence studied in the largest number of patients was anti-tumour necrosis factor (antiTNF) to vedolizumab (n=5336), followed by infliximab to adalimumab (n=3674) (Table 1). 30% reported data on biologics used as monotherapy, while 43% specified combination therapy (eg systemic steroids or immunomodulators). The commonest reason for undertaking a biologic switch was primary/secondary failure or intolerance (56% of studies). The use of therapeutic drug monitoring (TDM) to inform sequencing decisions was reported in 33% of publications. Aggregate response rates across 47 studies after changing biologic therapy were 49.0%; there was no significant difference between different sequence combinations in either CD or UC. Conclusion: This study highlights an imbalance in available data across different biologic sequencing choices, and the relative scarcity of good quality sequencing studies. Further prospective and registry studies are warranted into the comparative efficacy of different sequences of biologics and into the utility of TDM to guide treatment decisions.