Zhongwen Huang, PhD, Yi Ba, PhD, Song Wang, PhD, Pravin Kamble, PhD Takeda, Cambridge, MA
Introduction: Anti-TNF agents and α4β7 blocker are available treatment options for patients (pts) with moderate-to-severe CD. There are limited data on the optimal sequencing of these two mechanisms of action (MOAs) from the first line (1L) biologic to second line (2L) biologic treatment of CD to inform clinician’s decision making.
Methods: This retrospective study used the IBM® MarketScan® database to assess treatment pathways in a large U.S. insured population. Biologic naïve adult CD pts (identified using ICD-9 and 10 codes) who initiated (date of initiation defined as an index date) 1L biologic treatment (adalimumab [ADA], infliximab [IFX], certolizumab pegol [CTZ], or vedolizumab [VDZ] between 09/2016 and 12/2019) with at least 6 months of continuous health benefits enrolment post biologics initiation were included. Pts treated with biologics of different MOAs in 1L and 2L setting were identified to evaluate the treatment sequencing of either VDZ to anti-TNF or anti-TNF to VDZ. Treatment persistence was defined as time from index date to index drug discontinuation with a pre-defined gap of 90 days or switch to other biologic drugs.
Results: In the 1L, 535 VDZ and 4505 anti-TNF (2862 ADA, 1556 IFX, and 87 CTZ) pts were included. Among the 1L VDZ pts, only 35 switched to anti-TNF as 2L biologic treatment (VDZ to anti-TNF). Among the 1L anti-TNF pts, 265 switched to VDZ as 2L biologic therapy (anti-TNF to VDZ). Median 1L treatment persistence was 739 days in VDZ pts and 544 days in anti-TNF pts (log rank p=0.034). The median treatment persistence in 2L VDZ post anti-TNF was 625 days (anti-TNF to VDZ). The 6 months treatment persistence to 2L was estimated as 82.8% in VDZ to anti-TNF group and 80.2% in anti-TNF to VDZ group. The 6 months treatment persistence was estimated as 74.8% in 1L anti-TNF and 82.8% in 2L anti-TNF post VDZ (VDZ to anti-TNF).
Discussion: VDZ in 1L biologic treatment of CD was associated with significantly improved treatment persistence compared with anti-TNF agents. The sequencing of VDZ to anti-TNF had higher treatment persistence in both 1L and the first 6 months of 2L compared with the sequencing of anti-TNF to VDZ. The use of VDZ before anti-TNF agents was associated with higher persistence to anti-TNF in 2L than if anti-TNF was used in 1L during 6 months period of time. This real-world evidence from U.S. large database supports the use of VDZ prior to anti-TNF agents in biologic naïve pts with CD.
Zhongwen Huang, PhD, Yi Ba, PhD, Song Wang, PhD, Pravin Kamble, PhD. P2646 - Sequencing of Anti-TNF Agents and Vedolizumab in the Treatment of Crohn’s Disease (CD), ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
