P359. Systematic assessment of the frequency and risk factors of anti-TNF drug switch in the Swiss IBD Cohort
P. Hiroz1, N. Fournier2, E. Safroneeva3, S. Vavricka4, A. Schoepfer1, 1University Hospital Lausanne / CHUV, Gastroenterology and Hepatology, Lausanne, Switzerland, 2University of Lausanne, Institute of Social and Preventive Medicine, Lausanne, Switzerland, 3University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 4University Hospital Zurich, Gastroenterology and Hepatology, Zurich, Switzerland
The anti-TNF drugs infliximab (IFX), adalimumab (ADA), and certolizumab pegol (CZP) are effective in inducing and maintaining remission in inflammatory bowel disease (IBD. We aimed to evaluate the frequency of anti-TNF drug use and the prevalence of anti-TNF switches in the Swiss IBD Cohort.
Data from the Swiss IBD Cohort Study (SIBDCS) were analyzed. The SIBDCS includes patients retrospectively (IBD diagnosed before 2006) and since 2006 prospectively (diagnosed in 2006 and later). Eighty percent of the patients were included in hospital clinics and 20% in private practice.
From 2,014 patients (1,172 with Crohn's disease [CD], and 842 with ulcerative colitis [UC]), 759 (37.7%) were ever treated with at least one anti-TNF drug, corresponding to 563 (48.0%) of CD patients and 196 (23.3%) of UC patients. CD patients treated by anti-TNF drugs were significantly younger at CD diagnosis (24 vs. 29 years, P < 0.001), and more often had perianal disease (34.3% vs. 19.1%, P < 0.001) compared to the anti-TNF naïve group. Of the 563 CD patients ever treated with an anti-TNF drug, 75.0% were treated with one antibody, 19.4% with two antibodies, and 5.6% with three antibodies, respectively. Of the 196 UC patients ever treated with an anti-TNF drug, 84.4% were treated with one, 14.1% with two, and 1.5% with three antibodies. The frequency of use of the different anti-TNF drugs in CD was as follows: 86.7% IFX, 30.9% ADA, 17.2% CZP for CD. In UC, it was 94.4%, 21.9% and 2.6% for IFX, ADA, and CZP, respectively. Median treatment duration was longest for the first anti-TNF (CD: median 16.5 months, IQR 7.5–36.5; UC: median 7 months, IQR 3–15), followed by the second anti-TNF (CD: median 11.5 months, IQR 4–18; UC: median 4 months, IQR 2.7), and by the third anti-TNF (CD: median 3 months, IQR 1–7; no observations in UC). The IBD population undergoing an anti-TNF switch within the first 12 months of drug use showed a significantly longer time from IBD diagnosis until start with an anti-TNF drug compared to the group in which the anti-TNF drug was used >12 months (13.7 years vs. 6.8 years, p = 0.004).
Anti-TNF drugs were used in 48.0% of CD patients and 23.3% of UC patients of the SIBDCS. The treatment duration was longest for the first anti-TNF drug used, followed by the second and third anti-TNF. Long disease duration represents a risk factor for a need to switch the first used anti-TNF drug to the next one within the first 12 months of treatment.