A Retrospective Observational Study of Patterns of Biologic Drug Change in Inflammatory Bowel Disease

Introduction: Multiple therapies are currently available for inflammatory bowel disease (IBD); it is therefore crucial to understand patterns of drug change. This study aimed to examine the patterns of biological drug change and identify predictors of change in patients with IBD. Materials and Methods: We performed a retrospective study of patients diagnosed with IBD who were initiated on treatment with biologics between June 2017 and October 2022. The study's primary objective was to describe biologics drug change patterns. Secondary outcomes included identifying predictors of drug change. Results: 910 patients were screened; 475 patients were eligible. 319 (67%) had Crohn’s disease (CD), and 253 (53.3%) were males. The most selected first and second choice of biologic was adalimumab (58.2% and 39.1%, p<0.001) and infliximab (37.6% and 48.9%, p=0.004) for both CD and UC, respectively. On multiple regression analysis, a history of venous thromboembolism (VTE) (OR=3.60, p=0.025) and smoking (OR=0.34, p=0.026) were associated with drug change for all patients. When stratified by disease subtype, drug change was associated with a diagnosis made between age 17 and 40 years (OR=0.46, p=0.024) and extra intestinal manifestations (EIMs) (OR=2.07, p=0.015) in CD while selecting vedolizumab as first biologic (OR=0.30, p=0.041), male gender (OR=2.40, p=0.043), and history of VTE (OR=7.32, p=0.031) were associated with drug change in ulcerative colitis (UC). Conclusions: Despite introducing several new biologics, anti-TNF therapies remain the preferred first and second choice of biologics for patients with IBD. Multiple predictors of drug change over time exist for both diseases. Selecting vedolizumab as the first biologic for UC is associated with a lower risk of drug change.