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Poster presentations: Clinical: Therapy and Observation 2020

P508 Safety and efficacy of combining biological therapies together or with small molecules in patients with inflammatory bowel disease: A retrospective multicentre national observational case series study

L. Goessens1, J.F. Colombel2, A. Outtier3, M. Ferrante3, M. Truyens4, T. Lobaton4, F. Baert5, P. Bossuyt6, A. Cremer7, E. Macken8, B. Strubbe9, J.F. Rahier1

1CHU UCL Namur, Gastroenterology, Yvoir, Belgium, 2Icahn School of Medicine at Mount Sinai, Gastroenterology, New-York, USA, 3University Hospitals Leuven, Gastroenterology and Hepatology, Leuven, Belgium, 4University Hospital Gent, Gastroenterology, Gent, Belgium, 5AZ Delta, Gastroenterology, Roeselare, Belgium, 6Imelda General Hospital, Gastroenterology, Bonheiden, Belgium, 7Erasme University Hospital, Gastroenterology, Bruxelles, Belgium, 8University Hospital Antwerp, Gastroenterology, Edegem, Belgium, 9AZ Sint-Lucas, Gastroenterology, Gent, Belgium

Background

Few data are available regarding the combination of biological therapies (anti-TNF, anti-integrin, anti-interleukins (IL4, 12/23, 17A, 23)) or with a small molecule in patients with IBD. We here report the safety and efficacy of combining these drugs through a national retrospective multicenter case series.

Methods

Cases were extracted from local databases within the last 3 years. Combined therapy was defined as the concomitant use for a minimum of 1 day of 2 biologics or 1 biologic with a small molecule. Patients’ demographics, disease’ characteristics and types of combined therapies were recorded. Safety was defined as the occurrence of any serious adverse event (SAE): serious infection, opportunistic infection, any hospitalisation, cancer and death, whereas the efficacy of combination was clinically appreciated by physicians.

Results

From 8 centres, 23 combined therapies were observed in 19 IBD patients (74% Crohn’s disease, 21% ulcerative colitis and 5% IBD type unclassified). Median age at combination was 43.0 years ([IQR]: 31.5–59.0). Seventeen patients presented with a minimum of 1 concomitant IMID (ankylosing spondylitis (n = 11), psoriasis or psoriatic arthritis (n = 5) and other conditions (n = 5)). Reasons for starting a combination were active IBD (57%), another active IMID (30%) or both (13%). Anti-TNF and anti-integrin were combined in 11 cases, anti-TNF and anti-ILs in 5, anti-integrin and anti-ILs in 4 and other combinations in 3 (anti-TNF+rituximab+methotrexate; anti-IL4+anti-IL12/23; anti-IL12/23+methotrexate+leflunomide). The median duration of combined therapies was 5 months ([IQR]: 2–9). During 15.8 patients/years of combined therapy, 11 adverse events (AE) including 9 SAE were recorded in 8 patients. Eight infections were reported with various combinations: anti-TNF and anti-IL in 4 cases, anti-TNF and anti-integrin in 3 and anti-TNF+rituximab+methotrexate in 1. Two infections (both anti-TNF+ anti-integrin) were graded severe leading to hospitalisation, 6 were graded mild or moderate. Cancer and death were not observed. After combined therapy, IBD disease activity was clinically improved in 44% and remained stable in 50% of patients, whereas clinical improvement of IMID was observed in 25% of patients. Overall, the combination of treatments was withdrawn due to ineffectiveness or serious adverse events in 39% and 4%, respectively.

Conclusion

In our experience, the combination of biologics in patients with IBD ±. another IMID was associated with short term increased efficacy in almost half of patients but also with a risk of infections in one third. No new safety signals were observed in this difficult to treat patients but extensive data are urgently needed.