P0532Maintenance and Progression of Biologic Therapies in Patients with Crohn’s Disease

Abstract Background Treatment of Crohn’s disease (CD) has advanced, with increasing focus on optimizing biologic therapies to maintain remission. Therapeutic drug monitoring supports individualized management and prevention of loss of response. There is still a lack of data on treatment lines in underdeveloped countries. Therefore, this study assesses maintenance rates and treatment progression in CD. Methods Cross-sectional and descriptive study based on a retrospective review of electronic medical records of patients with CD followed at the Gastroenterology outpatient clinic of a philanthropic hospital. Results The sample included 112 participants (54 women and 58 men). Prior treatment with immunosuppressants had been administered to 67 patients, of whom 11 remained on monotherapy. Among the remaining 56 patients, 37.5% (21/56) were receiving combination therapy with azathioprine and a biologic agent, 51.7% (29/56) had escalated to advanced therapy without an immunosuppressant, and 10.7% (6/56) had discontinued azathioprine without initiating biologic therapy. A total of 92 patients initiated biologic therapy, including 25 individuals without prior immunosuppressant exposure. The overall maintenance rate on first-line biologic therapy was 58.7% (54 of 92 participants), with a mean treatment duration of 48 months. Maintenance rates by medication were: infliximab 60.3% (32/53), adalimumab 62.5% (20/32), ustekinumab 50% (1/2). Thirty-eight patients (42.3%) switched to a second-line biologic agent. Among these, the maintenance rate was 73.7% (28/38), with a mean duration of 25 months. Rates by medication were: infliximab 91.7% (11/12), adalimumab 78.9% (15/19), vedolizumab 33.3% (1/3), ustekinumab 25% (1/4). Ten patients (27%) switched to a third-line biologic therapy, which demonstrated a maintenance rate of 50% (5/10), with a mean duration of 16 months. Rates were: infliximab 33.3% (1/3), adalimumab 100% (2/2), ustekinumab 33.3% (1/3). Five of these patients (50%) progressed to a fourth-line biologic therapy, which showed a maintenance rate of 80% (4/5), with a mean duration of 22 months. Rates by medication were: adalimumab 100% (2/2), ustekinumab 100% (1/1), vedolizumab 0% (0/1). One patient (20%) initiated a fifth-line biologic therapy with infliximab, with a mean duration of 36 months. Conclusion Maintenance rates varied substantially across treatment lines, with reduced persistence after the second switch. Infliximab and adalimumab were the predominant first-line agents, maintaining good remission rates even when not used as first-line treatment. These findings highlight the importance of close monitoring and timely adjustments to preserve response and optimize sequencing of biologic therapy in CD. References: Macaluso FS, Papi C, Orlando A, et al. Use of biologics for the management of Crohn’s disease: IG-IBD clinical guidelines based on the GRADE methodology. Digestive and Liver Disease. 2023 Apr;55(4):442-453. doi: 10.1016/j.dld.2023.01.155. Shu-Ching Hsieh, Xiaoqin Wang, Zemin Bai, et al. Early Biologic Treatment for Inflammatory Bowel Disease: Drugs Internet. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2024 Oct. Lujan R, Buchuk R, Focht G, et al. Early Initiation of Biologics and Disease Outcomes in Adults and Children With Inflammatory Bowel Diseases: Results From the Epidemiology Group of the Nationwide Israeli Inflammatory Bowel Disease Research Nucleus Cohort. Gastroenterology. 2024;166(5):815-825.e22. doi: 10.1053/j.gastro.2024.01.041. Conflict of interest: Bertollo Ferreira, Felipe: Guimarães, Natalia: No conflict of interest Bertoldi, Gabriel: No conflict of interest Trotta Cure Salomão, Luiza: No conflict of interest Ferrari Khouri, Juliana: No conflict of interest Soares Lessa, Lara: No conflict of interest Destefani Natalia, Lucas: No conflict of interest Francischetto Ribeiro Viana, Marcela: No conflict of interest Dufrayer Fanzeres Monteiro Fortes, Isadora: No conflict of interest de Oliveira Fortunato, Luiza: No conflict of interest Frizzeira Lopes, João Pedro: No conflict of interest Soares Lessa, Lucas: No conflict of interest Hamer Sousa Clara, Ana Paula: No conflict of interest Welling Lorentz, Felipe: No conflict of interest Zardo Trindade, Livia: No conflict of interest Fabres do Carmo, Luiza: No conflict of interest Poltronieri Pacheco, Mariana: No conflict of interest