P453 The use of immunosuppresants is associated with high treatment persistence rates for infliximab and adalimumab as first or second line anti-TNF therapy in patients with inflammatory bowel disease

Theodoraki, E.(1);Orfanoudaki, E.(1);Foteinogiannopoulou, K.(1);Drygiannakis, I.(1);Koutroubakis, I.E.(1);

(1)University Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece


The aim of this study was to investigate the factors associated with treatment persistence for infliximab and adalimumab, as 1st or 2nd line anti-TNF therapy, in patients with inflammatory bowel disease (IBD).


A retrospective study of patients with IBD from the registry of our department who received infliximab (IFX) or adalimumab (ADA), during the period of 2002-2019 was performed. The persistence rate of IFX and ADA at 1 and 3 years from treatment initiation as 1st and 2nd line anti-TNF therapy respectively was calculated. In addition, possible related factors were analyzed.


We included 185 patients with IBD, naive to biologics, who initiated with anti-TNF treatment [105 men (57%), mean age (± SD) 44.5 ± 14.7 years, Crohn's disease 144 (78%), median disease duration (IQR) 13 (7-20) years, 120 (65%) under IFX, 100 (55%) in combination with immunosuppressive therapy for at least 6 months]. In 59 patients [Crohn’s disease 47 (80%)] IFX or ADA was used as 2nd line anti-TNF therapy. The duration of administration and persistence rate of IFX and ADA as 1st and 2nd line treatment are shown in Table 1.

In univariate analysis statistically significant associations between the persistence rates of anti-TNF therapy as first-line therapy, with the use of immunosuppressants (P = 0.04) and treatment intensification (P = 0.01) in both 1st and 3rd year (P = 0.01 and 0.04 respectively) were found. No other significant association between demographic, disease type and clinical parameters and treatment persistence was found. Regarding the 2nd line anti-TNF treatment, persistence of therapy in the 1st year was associated with treatment intensification (P = 0.02) and in the 3rd year of administration with the combination with immunosuppressants (P = 0.05). In multivariate analysis only the use of immunosuppresants remained statistically significant associated both in 1st and 3rd year of treatment in 1st line therapy (P=0.05 and P=0.003 respectively). This was also the case in 2nd line therapy but only in the 3rd year of treatment (P=0.05).

Table 1 Duration of administration and survival rate of IFX and ADA as 1st or 2nd line therapy

    1st line anti-TNF therapy2 nd line  anti-TNF therapy
Ν 185 59
Duration of administration (months)-[median (IQR)] IFX & ADA 47 (21-78.5) 32.5 (7-54)
IFX 58 (22.5-104) 19 (7-44)
ADA 33 (18.75-58.75) 33.5 (7.5-62.5)
Persistence rate 1st year3rd year1st year3rd year
IFX & ADA 87(160/185) 61(112/185) 70(41/59) 46(27/59)
IFX 87(104/120) 67(80/120) 71(10/14) 36(5/14)
ADA 86(56/65) 50(32/65) 69(31/45) 49(22/45)


The persistence rates of IFX and ADA used both as a 1st and 2nd line therapy in IBD patients are significantly associated with the combined use of immunosuppressants.