Sustainability of Biologic Therapy is Less in Ulcerative Colitis than Crohn’s Disease Patients, Independent of Prior Biologic Experience

Background: Treatment of Inflammatory Bowel Disease (IBD) with biologics is effective but loss of response to treatment limits long-term treatment success.Few studies have examined what determines sustainability of biologic treatment.Objective: The aim of our study was to determine factors associated with sustainability of biologic therapy in IBD.Methods: We performed a retrospective study of 4,200 patients in a single healthcare network.Primary outcome was time to biologic treatment discontinuation (due to inadequate treatment response or adverse effects).Results: A total of 948 independent biologic treatment episodes were identified in 712 patients.Mean follow-up was 2.3years (range 0.0028 -5.00).• Group 1: 701 biologic-naïve treatment episodes were included.329 patients (47%) were treated with infliximab, 337(48%) with adalimumab and 32(5%) with golimumab.250 (36%) had UC.Mean time to discontinuation in UC was 2.9 years compared to 3.6 years in CD (p = <0.001).• Group 2: 247 treatment episodes of biologic-experienced patients were included.83(33%) were treated with infliximab, 57(23%) with adalimumab, 40(16%) with vedolizumab, 26(11%) with golimumab and 41(16.6%)with ustekinumab.99(40 %) had UC.Mean time to discontinuation in UC was 2.3 years compared to 3.1 years in CD (p = 0.03).Conclusion: Our real-world data indicates sustainability of biologic treatment is less in UC than in CD patients and is not strongly determined by prior biologic exposure.These findings suggest the need for better understanding of the differing mechanisms for loss of biologic response which will assist in sequencing of therapies in the future.