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

Background

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

Methods

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 1^st and 2^nd line anti-TNF therapy respectively was calculated. In addition, possible related factors were analyzed.

Results

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 2^nd line anti-TNF therapy. The duration of administration and persistence rate of IFX and ADA as 1^st and 2^nd 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 1^st and 3^rd 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 2^nd line anti-TNF treatment, persistence of therapy in the 1^st year was associated with treatment intensification (P = 0.02) and in the 3^rd 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 1^st and 3^rd year of treatment in 1^st line therapy (P=0.05 and P=0.003 respectively). This was also the case in 2^nd line therapy but only in the 3^rd year of treatment (P=0.05).

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