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Poster presentations: Clinical: Therapy and Observation 2020

P327 Effectiveness of anti-TNF vs. vedolizumab as a second biologic in IBD: results from national Swedish registers

S. Rundquist1, M. Sachs2, C. Eriksson1, O. Olén3, S. Montgomery4, J. Halfvarson1, SWIBREG Study Group

1Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, 2Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden, 3Clinical Epidemiology Division, Department of Medicine Solna, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden, 4Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden

Background

We aimed to evaluate the effectiveness of tumour necrosis factor antagonist (anti-TNF) compared with vedolizumab (VDZ) as a second-line biological treatment in IBD.

Methods

A propensity score-matched cohort was created using data from the Swedish National Patient Register, the Swedish Quality Register for IBD (SWIBREG) and the Swedish Prescribed Drug Register. Patients with Crohn’s disease (CD) or ulcerative colitis (UC) exposed to anti-TNF as a first-line biologic, who initiated a second biologic agent 1 May 2014 – 31 December 2016 were included (n = 1363). We compared patients exposed to anti-TNF vs. patients exposed to VDZ as a second-line biologic treatment. The primary outcome was drug continuation rate at 12 months. Secondarily, we assessed survival without hospitalisation (because of IBD, complications of IBD or IBD-related surgery) and survival without IBD-related surgery. Risk of infections was investigated as survival without a) prescription of antibiotics and b) hospitalisation because of infection. Additionally, the proportion of patients on corticosteroids at 12 months was assessed.

Results

After 1:1 propensity score matching, the cohort was restricted to 400 patients (CD, n = 198; UC, n = 202). For CD, estimated drug continuation rate at 12 months was 72.7% in the VDZ-treated patients, compared with 73.7% in the anti-TNF treated patients (Figure 1A). Survival without IBD-related hospitalisation (81.8% vs. 87.9%, p = 0.25), IBD-related surgery (81.8% vs. 88.9%, p = 0.17), prescription of antibiotics (64.6% vs. 70.7%, p = 0.33) and hospitalisation due to infection (94.9 % vs. 87.9%, p = 0.08) did not significantly differ between the groups. Likewise, there was no statistically significant difference in proportions of patients on corticosteroids at 12 months (21.2% vs. 22.2%, p = 0.86). For UC, estimated drug continuation rate at 12 months was 69.3% in the VDZ-treated patients, compared with 62.4% in the anti-TNF treated patients (Figure 1B). VDZ treated patients had lower survival without IBD-related hospitalisation (82.2% vs. 93.1%, p = 0.02) and IBD-related surgery (82.2% vs. 94.1%, p = 0.01). Survival without antibiotics (81.2% vs. 70.3%, p = 0.08) and hospitalisation due to infection (92.1% vs. 92.1%, p = 0.97) as well as corticosteroid treatment at 12 months (17.8% vs. 23.8%, p = 0.30) did not differ significantly between the groups.

Conclusion

In this propensity score-matched cohort, the effectiveness and safety of anti-TNF and vedolizumab appear comparable when used as a second-line biologic in CD. In patients with UC, risk of hospitalisation and surgery was lower in patients treated with anti-TNF. Randomised controlled trials are needed to confirm these findings.

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