Adalimumab, Infliximab, and Vedolizumab in Treatment of Ulcerative Colitis: A Long-Term Retrospective Study in a Tertiary Referral Center

Abstract

Background Biological therapies have changed the landscape of pharmacological management of ulcerative colitis (UC). However, a large proportion of patients do not respond to biologics, lose their response over time or present adverse drug events. This study aims to assess therapeutic response and treatment persistence to adalimumab, infliximab and vedolizumab, three agents widely used in a tertiary referral centre of Saguenay-Lac-Saint-Jean (Quebec, Canada). Methods We conducted a retrospective population-based study with a thorough review of patient’s medical charts. Adults at UC diagnosis, with current or past use of adalimumab, infliximab or vedolizumab were included in the study. Clinical data were collected in order to assess response phenotypes and persistence to treatment. Kaplan Meier curves were performed to assess treatment persistence and predictors for discontinuation were assessed using Cox regression analyses. Results A total of 134 patients were included in this study. For the cases exposed to adalimumab, infliximab and vedolizumab, 56.9%, 62.5% and 47.5% were responders, respectively. Median persistence rates (95% CI) were 8.0 (3.3-12.8), 13.4 (9.3-17.5) and 3.4 (1.0-5.8) years for adalimumab, infliximab and vedolizumab, respectively. Increased persistence rates were observed in biologic-naïve in comparison to biologic-experienced patients treated with infliximab, but no such effect was observed for adalimumab or vedolizumab. Overall, 61.9% of cases had adverse drug events and of these, six lead to treatment discontinuation. Conclusion This study presents long-term treatment persistence data with adalimumab, infliximab and vedolizumab showing that more than half of cases treated with these biologics remained on treatment at least 12 months after initiation.

Predictive factors of response to infliximab therapy in Brazilian inflammatory bowel disease patients

“…30 Besides, favorable responses with IFX were observed in biologic-naïve patients compared to biologic-experienced patients. 31 These results are consistent with our data, as we observed that IBD patients who previously used IFX or adalimumab had a lower chance of clinical and endoscopic remission. Although we have 5-ASA derivatives, immunomodulators, and corticosteroids, it is important to emphasize that anti-TNF agents were the only advanced therapies available for IBD treatment in the Brazilian public health system during this study.…”

Meta‐analysis: Persistence of advanced therapies in the treatment of inflammatory bowel disease

“…Among the 63 publications, 10‐72 58 were journal articles and 5 were international conference abstracts. Two conference abstracts 71,72 were replaced by subsequent published articles found in our search.…”

Association of the TNFRSF1B rs1061622 variant with nonresponse to infliximab in ulcerative colitis

“…According to estimates from previous studies, 18-50% of anti-TNF treated UC patients did not show any improvement and 50 to 90% did not reach remission 10,11 . Moreover, 40 to 90% suffered from adverse events (AE) among which, 5-20% will be severe AE (SAE) 11,12 .…”

“…According to estimates from previous studies, 18-50% of anti-TNF treated UC patients did not show any improvement and 50 to 90% did not reach remission 10,11 . Moreover, 40 to 90% suffered from adverse events (AE) among which, 5-20% will be severe AE (SAE) 11,12 . This high variability in response to anti-TNF accentuates the need for precision medicine to limit the unnecessary exposure to ineffective molecules and occurrence of possible AE/SAE.…”