P1089Corticosteroid use during maintenance is associated with decreased persistence of advanced therapies in Ulcerative Colitis but not in Crohn’s Disease

Abstract Background Corticosteroids are used in ulcerative colitis (UC) and Crohn’s disease (CD) patients to induce remission. However, the impact of corticosteroid use during maintenance on advanced therapy (AT) persistence remains unclear. Methods We interrogated the Persistence Australian National IBD Cohort (PANIC5) registry from 2007-2021, covering all AT prescribing data for CD and UC in Australia. Non-persistence was defined as 6 months without dispensing. Maintenance corticosteroid use was defined as systemic corticosteroids ≥ 3 months after AT initiation. Kaplan-Meier curves were compared using the log-rank test. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI), P0.05 was considered significant. Results 19,087 CD and 9,671 UC patients underwent 31,967 and 14,784 lines of AT respectively, totaling 103,025 patient-years follow up. Maintenance corticosteroids were used in 15.2% of CD and 14.1% of UC patients. Corticosteroid use in UC was associated with reduced persistence of tumour necrosis factor inhibitor (TNFi) (median 20.0 vs 23.0 months, HR = 1.09 95%CI: 1.01-1.18, P=0.027), vedolizumab (25.0 vs 54.0, HR = 1.51 95%CI: 1.36-1.69, P0.001) and tofacitinib (median 8 months, HR = 2.47 95%CI: 1.02-5.95, P=0.036). In CD, corticosteroid use had no association with vedolizumab (median 39.0 vs 35.0 months, HR = 0.95 95%CI: 0.82-1.09, P=0.43) or ustekinumab persistence (median 52 months, HR = 1.11 95%CI: 0.96-1.28, P=0.14). Corticosteroid use in CD was associated with increased TNFi persistence (45.0 vs 37.0, HR = 0.92 95%CI: 0.88-0.96, P0.001). Conclusion Corticosteroid use during maintenance is associated with reduced persistence of TNFi, vedolizumab and tofacitinib in UC. This highlights that corticosteroid-requiring flares may signal the need to change AT. In contrast, corticosteroid use did not affect ustekinumab or vedolizumab in CD and was associated with increased TNFi persistence in CD, suggesting the potential for salvage with dose optimisation and/or combination therapy. Conflict of interest: Dr. Gu, Bonita: Dr Bonita Gu has received sponsorship for conference attendance from Johnson & Johnson and Ferring. Chetwood, John: Speaker fees: Novartis, Eli Lilly, Dr Falk Pharma, Johnson & Johnson Pudipeddi, Aviv: Aviv Pudipeddi has received speaker honoraria or advisory board fees from AbbVie, Dr Falk Pharma, Ferring, Johnson & Johnson, Pfizer and Takeda. Yau, Yunki: No conflict of interest Kariyawasam, Viraj: VK has received speaker fees from Janssen, AbbVie, Ferring, Takeda, Pfizer, Shire, Chiesi, Celltrion, GSK, Eli Lilly, Research Review, and Limbic has served on advisory boards for Janssen, Takeda, Ferring, and AbbVie has received educational grants and/or research support from Ferring, Janssen, AbbVie, Takeda, Shire, the Western Sydney Local Health District (WSLHD) Research and Education Network, and Crohn’s and Colitis Foundation (USA) and is a board director of IBD Sydney. Paramsothy, Sudarshan: SP has received speaker / advisory board fees from AbbVie, Dr Falk Pharma, Ferring, Janssen and Takeda. Leong, Rupert: advisory board: AbbVie, Aspen, BMS, Celgene, Celltrion, Chiesi, Ferring, Glutagen, Hospira, Janssen, Lilly, MSD, Novartis, Pfizer, Prometheus Biosciences, Takeda, Spyre, Roche research grants: Joanna Tiddy USYD, McCusker Charitable Foundation, Celltrion, Shire, Janssen, Takeda, Gastroenterological Society of Australia, NHMRC, Gutsy Group, Pfizer