P220 Predictors of prognosis after discontinuation of first-use biologics in IBD patients with at least 24 months follow-up

• Published in: Journal of Crohn's and colitis 2020-01, Vol.14 (Supplement_1), p.S252-S253
• Main Authors: Shivaji, U N, Bazarova, A, Critchlow, T, Smith, S C, Nardone, O M, Love, M, Davis, J, Ghosh, S, Iacucci, M
• Format: Article
• Language: English
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjz203.349

Abstract Background In clinical practice, patients with IBD have their biologic therapies withdrawn due to variety of reasons. The aim of the study was to report on predictors of prognosis in IBD patients after biologics have been discontinued, with a minimum follow-up of 24 months. Methods All IBD patients who discontinued their first-use biologic were identified between January 2013 and Dec 2016 from EMR at a tertiary referral centre, to ensure at least 24 months follow-up. Reasons for discontinuation and pre-defined adverse outcomes (steroid and other rescue therapies, hospitalisations, surgery including perianal) were recorded. The data were analysed using multivariable and univariable logistic regressions within a machine learning technique in order to predict adverse outcomes, within the stated timeframe. We tested the significance of the identified predictors and performed Kaplan–Meier survival analysis to compare patients with elective vs. non-elective discontinuation of biologics. Results 147 patients who discontinued biologics (M = 74, median age 39y; CD = 110) were identified. Follow-up ranged from 24 to 60 months (median 40 months). The reasons for non-elective discontinuation included side effects (n = 21, 14%), primary or secondary non-response (n = 33, 22%) and patient choice (n = 10, 7%), among others. 59 (40%) patients had elective discontinuation. In this cohort, elective discontinuation resulted in fewer IBD-related adverse outcomes (AO) compared with non-elective. Figure 1 shows a Kaplan–Meier curve comparing the two (p = 0.003). Using data from all 147 patients, multivariable logistic regression analysis was done to identify significant predictors of prognosis. These are represented in Table 1. Overall, a significant number of patients (n = 80, 54%) had AO within 6 months of discontinuation, and 96 (65%) patients needed biologics to be restarted by the end of the study follow-up period. Predictors of poor outcomes Time interval when significant AUROC Odds ratio (OR) and confidence intervals Statistically significant? Asian race < 6 months 0.6283 OR 0.68 95% CI (0.49,0.95) Yes Secondary non-response < 6 months 6–12 months 12–24 months >24 months 0.6715 OR 7.09 95% CI (1.60,29.97) Yes Steroid therapy 12–24 months 0.6219 OR 0.24 95% CI (0.04,0.88) Yes Predictors of good outcomes Male sex >24 months 0.638 OR 0.31 95% CI (0.09,0.85) Yes Elective stop