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P508. Drug survival and reasons for discontinuation of anti-TNF therapy in inflammatory bowel disease (IBD) in clinical practice

J.P. Gisbert1, M. Arredondo2, M. Chaparro1, I. Cañamares2, E. Daudén3, G. Fernández-Jiménez4, V. Meca5, A. Morell2, L. Carmona6, J.M. Alvaro-Gracia7, 1Hospital Universitario de La Princesa, IP and CIBERehd, Gastroenterology Unit, Madrid, Spain, 2Hospital Universitario de La Princesa and IP, Farmacy Unit, Madrid, Spain, 3Hospital Universitario de La Princesa and IP, Dermatology Unit, Madrid, Spain, 4Hospital Universitario de La Princesa and IP, Documentation Service, Madrid, Spain, 5Hospital Universitario de La Princesa and IP, Neurology Unit, Madrid, Spain, 6Institute for Musculoskeletal Health, Madrid, Spain, 7Hospital Universitario de La Princesa and IP, Biological Therapies Unit, Madrid, Spain

Background

Since its introduction, anti-TNF therapy has shown to be effective for the treatment of IBD in several clinical trials. However, its long-term effectiveness and reasons for discontinuation in clinical practice might be different from those observed in clinical trials.

Aims: To evaluate the drug survival and reasons for discontinuation of the first anti-TNF therapy in IBD patients in clinical practice.

Methods

IBD patients under anti-TNF therapy from 2000 to 2012 in our center were included. Data regarding the first anti-TNF treatment were extracted from clinical records fulfilled prospectively. Kaplan–Meier method was used to estimate the long-term drug survival of the treatment.

Results

160 IBD patients were included: 130 with Crohn's disease (mean age 42±14 years; 47% male) and 30 with ulcerative colitis (mean age 45±17 years; 63% male). The distribution of first biologic in Crohn's disease was 76 (58%) adalimumab and 54 (42%) infliximab, while in ulcerative colitis it was 1 (3%) adalimumab and 29 (97%) infliximab. Time to a probability of 50% discontinuation was 3.94 years in Crohn's disease compared with 0.97 years in ulcerative colitis (p < 0.001). The reasons for discontinuation of the drug, respectively in Crohn's disease and ulcerative colitis, were: intolerance (20% and 19%), lack of response (30% and 24%), loss of response (22% and 19%), remission achievement (17% and 29%), and others (11% and 10%). The probability of maintaining (retention rate) the anti-TNF treatment in Crohn's disease was 69% at 1 year, 59% at 2 years, 52% at 3 years, 50% at 4 years, 45% at 5 years, and 41% at 10 years. The corresponding figures for ulcerative colitis were 48% at 1 year, 41% at 2 years, 36% at 3 years, 31% at 4 years, and 15% at 5, 6 and 7 years.

Conclusion

The probability of maintaining the first anti-TNF drug in Crohn's disease patients is around 50% after 5 years of treatment. Discontinuation rate was even higher in ulcerative colitis, with only 15% of patients maintaining anti-TNF therapy at 5 years. The most frequent reasons for discontinuation of anti-TNF therapy were lack of response, loss of response, remission achievement and intolerance.