B0416 - Factors Associated With Overall Response to Biologic Therapy

Anoushka Dua, MD¹, Preeti Prakash, MD², Vivy Cusumano, MD³, Jenny Sauk, MD¹, Berkeley Limketkai, MD, PhD^4
1University of California, Los Angeles, Los Angeles, CA; ²UCLA, Los Angeles, CA; ³University of California Los Angeles, Los Angeles, CA; ⁴UCLA School of Medicine, Los Angeles, CA

Introduction: The advent of biologic therapy has revolutionized the approach to treating patients with inflammatory bowel disease (IBD). However, up to 40% of patients do not respond to initial biologic therapy, prompting a switch to a new biologic. Factors associated with primary response to initial biologic therapy have been described, though literature is conflicting. We aim to explore factors that predict overall response to biologic therapy using real-world data, considering patients who have been on multiple biologics.

Methods: We conducted a retrospective chart review of patients age ≥ 18 years with IBD who received between one to three biologic therapies between 2015 and 2021 at a single tertiary care center. Demographic data, baseline disease characteristics, treatment history, laboratory values, clinical activity scores, and endoscopy reports were abstracted. Response to therapy was defined by low clinical disease activity scores, low calprotectin, and inactive disease on endoscopy (Table). Multivariable logistic regression was used to evaluate patient- and disease-specific factors associated with response to biologic therapy.

Results: There were 773 subjects with 1246 initiations of a biologic drug (78% anti-tumor necrosis factor). Mean age was 36.8 (standard deviation 15.5) years, and 52.1% had Crohn’s disease. 217 patients had only been treated with one prior biologic, and 128 patients had been treated with two prior biologics. Factors that predicted poor response to biologic therapy included use of two prior biologics (aOR 0.63, 95% CI 0.40-0.98) and diagnosis of primary sclerosing cholangitis (PSC) (OR 0.38, 95% CI 0.16-9.92) (Table). Concurrent use of an immunomodulator predicted response to therapy (aOR 1.63, 95% CI 1.22-2.19). Age, sex, race, smoking status, concurrent 5-ASA or steroid use, disease duration, and prior IBD surgery were not associated with clinical response to biologics overall.

Discussion: Pharmacologic management of patients with IBD is complex, and decisions regarding treatment initiation are multifactorial. Providers should consider that patients with PSC may have suboptimal response to biologic therapy, and concurrent prescription of an immunomodulator may improve the likelihood of response, independent of prior biologic therapy. Lack of response to two prior biologics should prompt an early multidisciplinary discussion about next steps in treatment, given high likelihood of poor response to a third biologic.



Disclosures:


Anoushka Dua, MD¹, Preeti Prakash, MD², Vivy Cusumano, MD³, Jenny Sauk, MD¹, Berkeley Limketkai, MD, PhD⁴. B0416 - Factors Associated With Overall Response to Biologic Therapy, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.