Patient-Preferences Favoring Treatment Discontinuation Are Reduced With Vedolizumab and Ustekinumab Compared With TNF Antagonists in Inflammatory Bowel Disease

Abstract

Background Non-adherence to biologic therapy in inflammatory bowel disease (IBD) is associated with risk of relapse, immunogenicity, and disease complications. Significant non-adherence prevalence is reported with TNF-antagonists but the risk of non-adherence with newer biologics with better safety profiles is unknown.This study aimed to investigate if IBD patient-preferences favoring biologic discontinuation vary by biologic class and analyze factors associated with such preferences. Methods A convenience sample of 200 adults with IBD on biologic therapy treated at an academic outpatient center was surveyed using a 22-point questionnaire. Patient-preference favoring treatment discontinuation between TNF-antagonist and non-TNF-antagonist biologics [vedolizumab (VDZ)/ustekinumab (UST)] was compared using χ 2 test. Risk factors associated with a preference to discontinue biologic therapy were evaluated using univariable and multivariable logistic regression, and Spearman rank correlation analyses. Results A total of 190 questionnaires were analyzed that contained data on preferences regarding biologic discontinuation [median age 36 years, 62% were females; 63% had Crohn’s disease; 56% were receiving a TNF-antagonist, 31% VDZ and 14% UST]. Overall, 32% patients reported a preference to discontinue biologic treatment with a higher proportion among those receiving a TNF-antagonist compared with VDZ/UST (39.6% vs 21.4%; p<0.01). Current VDZ/UST use was independently associated with a reduced odds of patient-preference favoring biologic discontinuation [adjusted OR: 2.67 (1.42-5.01); p<0.01]. The most concerning factor to patients was the perceived risk of side-effects. Patients on VDZ/UST perceived their therapy to be safer than those receiving a TNF-antagonist (r=0.2, p=0.04). Conclusion Patient-preference favoring treatment discontinuation is improved with VDZ/UST compared with TNF-antagonist biologic therapy.

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

“…Kumar et al. investigated patient preferences regarding biological agent discontinuation and noted a higher proportion of patients preferring to discontinue TNFi compared to vedolizumab or ustekinumab due to perceived side effects and the risk of loss of response 82 …”