P648 Effectiveness of Biologic Therapies in Decreasing Risk of Hospitalization and Surgery, Maintaining Steroid Free Remission and Achieving Mucosal Healing in Inflammatory Bowel Disease; Real World Data.
Shehab, M.(1)*;Abdullah, I.(1);Alostad, W.(1);Marei, A.(1);Alfadhli, A.(1);
(1)Mubarak Al-Kabeer Hospital, Internal medicine, Kuwait, Kuwait;
Background
Several biologic therapies are currently available for the management of inflammatory bowel disease (IBD) rendering the choice and sequencing between them as a first line under question. In our study, we evaluated the effectiveness of biologic therapies in achieving important clinical and endoscopic outcomes in biologic naïve patients with IBD.
Methods
Electronic medical records of patients with moderate to severe IBD, who were previously naïve to biologics, were reviewed and evaluated retrospectively in a tertiary care gastroenterology center, Haya Alhabib Center. Patients who were on infliximab, adalimumab, ustekinumab and vedolizumab for 12 months were included. The primary end points were percentage of hospitalization, surgery, steroid free remission, and mucosal healing, defined as Mayo score less than 1 in ulcerative colitis and SES-CD score less than 3 in Crohn’s disease. Descriptive analysis was performed to measure outcomes.
Results
A total of 335 biologic naïve patients with IBD were included; 262 (78.2%) patients with ulcerative colitis and 73 (21.8%) patients with Crohn’s disease. Regarding hospitalization, 25 (14.7%) out of 170 on adalimumab,12 (10.7%) out of 112 on infliximab, and one (6.25%) on vedolizumab were hospitalized. None of the patients on ustekinumab were hospitalized. 9 out of 171 (4.7%) patients on adalimumab underwent surgery, while none of the patients on the other biologics underwent IBD related surgery. Regarding steroid free remission, 29 (16.9%) out of 171 patients on adalimumab received steroid courses, 15 (13.3%) out of 113 patients on infliximab, 4 (11.4%) out of 35 patients on ustekinumab, and 1 (6.3%) out of 16 patients on vedolizumab. A total of 159 out of 171 patients (93.0%) on adalimumab achieved mucosal healing. While 100 out of 113 patients (88.5%) on infliximab, 26 out of 35 patients (74.3%) on ustekinumab, and 7 out of 16 patients (43.8%) on vedolizumab achieved mucosal healing.
Conclusion
Adalimumab, infliximab, and ustekinumab and vedolizumab were all effective in inducing steroid free remission. However, patients on vedolizumab had numerically lower percentages of mucosal healing than other biologics. Percentage of hospitalizations and IBD related surgeries were higher in patients on infliximab and adalimumab. Future Larger prospective comparative studies are needed.