P0599Ustekinumab has the highest persistence in Crohn’s Disease, vedolizumab has the highest persistence in Ulcerative Colitis, and persistence declines from first- to fourth-line therapy

Abstract Background Multiple advanced therapies (ATs) are available for Crohn’s disease (CD) and ulcerative colitis (UC), but optimal sequencing remains unclear. We evaluated 12-month persistence, an endpoint aligned with clinical trial outcomes, and characterised persistence patterns across drug classes and lines of therapy. Methods We interrogated the Persistence Australian National IBD Cohort (PANIC5) registry from 2017-2021, covering all Australian prescribing data for CD and UC. Persistence at 12 months was defined as the proportion of patients remaining on AT. Patients with 12 months of follow-up who remained on AT were excluded. The maximum follow-up duration for tofacitinib was 8 months, so all patients were included and assessed at last follow up. The Cochran-Armitage test and Z-statistic were used to assess for trends in persistence across treatment lines. 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. For first-line treatment in CD, ustekinumab had the highest persistence (80.0%) versus vedolizumab (77.1%), infliximab (73.8%) and adalimumab (73.8%, P0.001). There was a significant decrease in persistence across lines of therapy for infliximab (Z=-7.3, P0.001), adalimumab (Z=-12.6, P0.001), vedolizumab (Z=-6.6, P0.001) and ustekinumab (Z=-6.4, P0.001; Figure 1). For first-line treatment in UC, vedolizumab had the highest persistence (78.0%) versus infliximab (63.6%) and adalimumab (59.3%, P0.001). There was a significant decrease in persistence across lines of therapy for infliximab (Z=-7.4, P0.001), adalimumab (Z=-5.0, P0.001) and vedolizumab (Z=-10.9, P0.001; Figure 1). Tofacitinib had 93.1% persistence at the maximum follow-up duration of 8 months. There was no change in tofacitinib persistence across lines of therapy (Z=-15.1, P=0.41). Similar findings were found for infliximab, adalimumab, vedolizumab and ustekinumab using an eight-month endpoint (P0.001). Conclusion Ustekinumab had the highest persistence at 12 months in CD whereas vedolizumab had the highest persistence in UC. Persistence declined with each line of therapy, except for tofacitinib in UC. 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: Educational grants or research support – Ferring, Janssen, AbbVie, Takeda, Shire, WSLHD Research and Education network, Crohn’s and Colitis USA Speaker fees – Janssen, AbbVie, Ferring, Takeda, Pfizer, Shire, Chiesi, Celltrion, GSK, Eli-Lilly, Research Review, Limbic Advisory boards – Janssen, Takeda, Ferring, AbbVie Board director- IBD Sydney organisation (not for profit) 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