Comparative Effectiveness of Biologics for Endoscopic Healing of the Ileum and Colon in Crohn's Disease

Narula, Neeraj; Wong, Emily C L; Dulai, Parambir S.; Marshall, John K.; Jairath, Vipul; Reinisch, Walter

doi:10.14309/ajg.0000000000001795

Cited by 36 publications

(17 citation statements)

References 44 publications

(55 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our finding that adalimumab-treated patients incurred lower CD-related HRU compared to vedolizumab-treated patients is consistent with the findings reported in existing literature, and may be partially attributable to the superiority of anti-TNFs versus α 4 β 7 integrin blockers in healing small bowel for patients with CD. 35 Despite both adalimumab and vedolizumab effectively leading to endoscopic remissions in moderate-to-severe inflammatory bowel disease (IBD), different findings have been reported in CD versus UC. The VARSITY trial 23 showed superiority of vedolizumab over adalimumab in UC regarding endoscopic improvement at week 52.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Adalimumab Is Associated With Lower Healthcare Resource and Steroid Use Versus Vedolizumab in Biologic-Naive Crohn’s Disease: A Retrospective Claims Database Analysis

Ungaro

Griffith

García-Horton

et al. 2022

Crohn's &Amp; Colitis 360

View full text Add to dashboard Cite

Background We compared real-world healthcare resource utilization (HRU), Crohn’s disease (CD)-related complications, and time to systemic corticosteroid discontinuation between patients with CD treated with adalimumab versus vedolizumab as initial biologic. Methods Biologic-naïve adults with CD and ≥2 claims between 05/20/2014–09/30/2019 for adalimumab or vedolizumab were identified in the IBM® MarketScan® research database. Patient characteristics were assessed during the 6-month baseline period before biologic initiation (index date). Adalimumab- and vedolizumab-treated patients were propensity-score matched 1:1 on demographics, disease characteristics, and comorbidities with ≥10% prevalence that differed significantly between groups. Categorical, continuous, and time-to-event outcomes between groups during the 12-month follow-up on/after index were compared with chi-square tests, Wilcoxon rank-sum tests, and Kaplan-Meier analyses, respectively. Results Adalimumab- and vedolizumab-treated patients were matched (n=461 per group) and baseline characteristics balanced. Significantly fewer adalimumab- versus vedolizumab-treated patients had a CD-related emergency room visit (12-month proportion: 14.5% vs 21.0%; log-rank p<0.01) or inpatient admission (14.9% vs 20.2%; log-rank p<0.05). Rates of CD-related surgeries were similar (9.3% vs 11.5%; log-rank p=0.282). Among patients without internal/perianal abscess or fistula or intestinal stricture at baseline (NADA=360, NVDZ=364), numerically but not significantly fewer adalimumab- versus vedolizumab-treated patients had CD-related complications at 12 months (18.3% vs 22.3%; p=0.171). Among patients with corticosteroid use at index (NADA=143, NVDZ=139), significantly more adalimumab- versus vedolizumab-treated patients discontinued corticosteroids (12-month proportion: 90.2% vs. 76.3%; log-rank p<0.001). Conclusions Patients with CD treated with adalimumab as their first biologic experienced significantly lower CD-related HRU and were more likely to discontinue corticosteroids compared to vedolizumab-treated patients.

show abstract

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a 2022 post-hoc analysis of pooled data from patients with moderate-to-severe CD from four clinical trials reported superior rates of one-year endoscopic healing in adalimumab-treated and infliximab-treated patients than vedolizumab-treated patients. 35 …”

Section: Discussionmentioning

confidence: 99%

Adalimumab Is Associated With Lower Healthcare Resource and Steroid Use Versus Vedolizumab in Biologic-Naive Crohn’s Disease: A Retrospective Claims Database Analysis

Ungaro

Griffith

García-Horton

et al. 2022

Crohn's &Amp; Colitis 360

View full text Add to dashboard Cite

show abstract

“…We observed class membership to be associated with early biologic treatment. It is arguably reasonable to expect an association between biologic treatments and FCAL profiles given the often-reported association between FCAL and endoscopic activity and an association between biologic treatments and endoscopic healing for CD patients 33,34 .…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Faecal Calprotectin Profiles Characterise Disease Course Heterogeneity in Crohn’s Disease

Constantine‐Cooke

Monterrubio-Gómez

Plevris

et al. 2022

Preprint

View full text Add to dashboard Cite

Background High faecal calprotectin is associated with poor outcomes in Crohn's disease. Monitoring of faecal calprotectin trajectories could characterise disease progression before severe complications occur. Aims We undertook an unbiased assessment of a retrospective incident Crohn's disease cohort to assess for inter-individual variability in faecal calprotectin levels over time. We aimed to explore whether latent classes of such profiles are associated with a composite endpoint consisting of surgery, hospitalisation, or Montreal behaviour progression and other clinical information. Methods Latent class mixed models were used to model faecal calprotectin trajectories within five years of diagnosis. Akaike information criterion, Bayesian information criterion, alluvial plots, and class-specific trajectories were used to decide the optimal number of classes. Log-rank tests of Kaplan-Meier estimators were used to test for associations between class membership and outcomes. Results Our study cohort comprised 365 subjects and 2856 faecal calprotectin measurements (median 7 per subject). Four latent classes were found and broadly described as a class with consistently high faecal calprotectin and three classes characterised by downward trends for calprotectin. Class membership was significantly associated with the composite endpoint, and separately, hospitalisation and Montreal disease progression, but not surgery. Early biologic therapy was strongly associated with class membership. Conclusions Our analysis provides a novel stratification approach for Crohn's disease patients based on faecal calprotectin trajectories. Characterising this heterogeneity helps to better understand different patterns of disease progression and to identify those with a higher risk of worse outcomes. Ultimately, this information will assist the design of more targeted interventions.

show abstract

“…Narula et al [21] recently performed a post hoc analysis of pooled participant-level data from several clinical trials of biologics in patients with moderate to severe CD. Overall, ileal and colonic endoscopic healing were separately assessed using each segment score of the SES-CD.…”

Section: Difference In Endoscopic Healing Between the Small Bowel And...mentioning

confidence: 99%

Clinical Impact of Endoscopic Evaluation of the Small Bowel in Crohn’s Disease

Esaki¹,

Sakata²

2022

Digestion

View full text Add to dashboard Cite

Background: The STRIDE-II position statement has established endoscopic healing as the long-term target of treatment for inflammatory bowel disease, and ileocolonoscopy is considered the gold standard for assessment of endoscopic healing. However, precise assessment of endoscopic healing cannot be achieved by ileocolonoscopy alone in patients with Crohn’s disease (CD). Summary: Approximately 70–80% of patients with CD have small bowel disease, and intestinal complications develop more frequently in the small bowel than in the colorectum. The recent advent of small bowel capsule endoscopy and balloon-assisted enteroscopy has not only clarified the higher incidence of proximal small bowel lesions but has also revealed the presence of such lesions as a possible risk factor for poor disease outcomes. Evidence has shown that the therapeutic efficacy of biologics may differ between the small bowel and the colorectum. In the postoperative setting, it was recently recognized that intestinal lesions other than those at the anastomotic site should be carefully monitored considering the risk of postoperative recurrence. However, there are some obstacles to implementing endoscopic assessment of the entire small bowel and colorectum. Inflammatory biomarkers might play important roles in such scenarios, but the predictive value of biomarkers for small bowel endoscopic healing remains controversial. Key Messages: Endoscopic assessment of the small bowel is indispensable for improvement of the long-term outcome of CD. The validity of endoscopic healing and transmural healing as long-term targets remains to be fully elucidated.

show abstract

Comparative Effectiveness of Biologics for Endoscopic Healing of the Ileum and Colon in Crohn's Disease

Cited by 36 publications

References 44 publications

Adalimumab Is Associated With Lower Healthcare Resource and Steroid Use Versus Vedolizumab in Biologic-Naive Crohn’s Disease: A Retrospective Claims Database Analysis

Adalimumab Is Associated With Lower Healthcare Resource and Steroid Use Versus Vedolizumab in Biologic-Naive Crohn’s Disease: A Retrospective Claims Database Analysis

Longitudinal Faecal Calprotectin Profiles Characterise Disease Course Heterogeneity in Crohn’s Disease

Clinical Impact of Endoscopic Evaluation of the Small Bowel in Crohn’s Disease

Contact Info

Product

Resources

About