EVALUATION OF CONCOMITANT CORTICOSTEROID AND VEDOLIZUMAB USE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD) IN REAL-LIFE CLINICAL PRACTICE

• Published in: Value in health 2017-05, Vol.20 (5), p.A180
• Main Authors: Ylisaukko-Oja, T, Torvinen, S, Aaltonen, J, Vihervaara, V, Eberl, A, Nuutinen, H, Blomster, T, Jussila, A, Pajala, M, Jokelainen, J, Herrala, S, Tamminen, K, Sipponen, T
• Format: Article
• Language: English
• Subjects: Biological products; Chart reviews; Clinical medicine; Corticosteroids; Crohn's disease; Discontinued; Drug therapy; Drug use; Inflammatory bowel disease; Inflammatory bowel diseases; Intestine; Monoclonal antibodies; Patients; Side effects; Tumor necrosis factor-α; Ulcerative colitis
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Corticosteroids (CS) are often used concominantly with biologies in treatment of inflammatory bowel disease (IBD). However, their side-effect profile causes significant clinical and economic burden in long-term treatment. In this study, we investigated the impact of concomitant CS use on vedolizumab treatment persistence in patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS: This was a nationwide (Finland), retrospective, non-interventional, multi-center chart review. From 27 centers, we included adult (≥ 18 years of age) IBD patients who received at least one vedolizumab infusion since 2014. Data were collected from medical charts in a standardized case report form. The key data collection points were at baseline, week 14 and month 6 of vedolizumab treatment RESULTS: 247 patients (CD 108, UC 139) were included. At baseline, 47 (43.5%) CD and 84 (60.4%) UC patients were using CS. Higher percentage of patients using CS at baseline discontinued vedolizumab during the 6-month follow-up compared to CS non-users (CD, 14/47 (29.8%) vs. 13/61 (21.3%); UC, 31/84 (36.9%) vs. 16/55 (29.1%)). Over half of the patients on CS at baseline and who persisted on vedolizumab were able to discontinue CS before 6 months timepoint (CD, 18/33 (54.5%); UC, 37/53 (69.8%)). Among CD patients, CS users had higher baseline disease activity than non-users. Such difference was not observed in UC. CS users had shorter disease duration in both CD and UC. There was no difference in the number of prior TNF-alpha inhibitors between CS users and non-users. CONCLUSIONS: Vedolizumab treatment persistence was lower in CS users than in non-users in both CD and UC. The majority of patients on CS at baseline who persisted on vedolizumab were steroid-free by 6 months, potentially relieving the burden of CS-induced side-effects for both patients and society.