Predictors of drug survival: A cohort study comparing anti‐tumour necrosis factor agents using the Swedish inflammatory bowel disease quality register

• Published in: Alimentary pharmacology & therapeutics 2021-10, Vol.54 (7), p.931-943
• Main Authors: Visuri, Isabella, Eriksson, Carl, Olén, Ola, Cao, Yang, Mårdberg, Emelie, Grip, Olof, Gustavsson, Anders, Hjortswang, Henrik, Karling, Pontus, Montgomery, Scott, Myrelid, Pär, Ludvigsson, Jonas F., Halfvarson, Jonas
• Format: Article
• Language: English
• Subjects: Cohort analysis; Crohn's disease; Decision making; Immunomodulation; Inflammatory bowel diseases; Infliximab; Monoclonal antibodies; Patients; Survival; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Tumors; Ulcerative colitis
• ISSN: 0269-2813; 1365-2036; 1365-2036
• DOI: 10.1111/apt.16525

Summary Background Whether long‐term effectiveness differs between anti‐tumour necrosis factor (anti‐TNF) agents is unknown. Aims To examine drug survival of first‐line anti‐TNF agents and identify predictors of discontinuation. To reduce channelling bias, we also compared drug survival of the second anti‐TNF. Methods Biologic‐naïve patients (N = 955) recorded in the Swedish IBD Quality Register (SWIBREG) were examined. We used propensity score matching, comparing drug survival over up to three years of follow‐up. Cox regression estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Results In Crohn's disease, discontinuation because of lack/loss of response was 32% [95%CI = 26%‐38%] for infliximab versus 16% [95%CI = 11%‐21%] for adalimumab. Infliximab [vs adalimumab; aHR = 1.96; 95%CI = 1.20‐3.21] and colonic disease (L2) [vs no L2; aHR = 2.17; 95% CI = 1.26‐3.75] were associated with higher discontinuation rates, whereas normalised CRP at three months [aHR = 0.40; 95% CI = 0.19‒0.81] with a lower rate. Consistently, patients who switched from adalimumab to infliximab (vs infliximab to adalimumab) had earlier discontinuation (P = 0.04). Concomitant use of immunomodulators was associated with a lower adverse drug reaction‐mediated discontinuation rate [aHR = 0.46; 95% CI = 0.28‐0.77], in part explained by fewer infusion reactions [aHR = 0.27; 95% CI = 0.08‐0.89]. In ulcerative colitis, the probability of discontinuation because of lack/loss of response was 40% [95% CI = 33%‐47%] for infliximab versus 37% [95% CI = 21%‐53%] for adalimumab. Disease duration ≥10 years [aHR = 0.25; 95% CI = 0.10‐0.58] and normalised CRP after three months [aHR = 0.39; 95% CI = 0.18‒0.84] were associated with lower discontinuation rates. Conclusions Clinical characterisation of patients may aid decision‐making on anti‐TNF treatment. The consistently shorter drug survival for infliximab (vs adalimumab) in Crohn's disease, suggests a potential difference between the two drugs. Predictors of drug survival: a cohort study comparing anti‐tumour necrosis factor agents using the Swedish inflammatory bowel disease quality register (SWIBREG)