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P556. Appropriateness and long-term discontinuation rate of biological therapies in ulcerative colitis

M.H. Maillard1, M. Bortolotti2, J.-P. Vader2, C. Mottet3, A. Schoepfer1, J.-J. Gonvers1, B. Burnand2, F. Froehlich4, P. Michetti5, V. Pittet2, 1Lausanne University Hospital, Department of Gastroenterology & Hepatology, Lausanne, Switzerland, 2Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Lausanne, Switzerland, 3Hôpital Neuchâtelois, Service of Gastroenterology, Neuchâtel, Switzerland, 4University Hospital Basel, Division of Gastroenterology & Hepatology, Basel, Switzerland, 5Clinique La Source-Beaulieu, Crohn and Colitis Center, Lausanne, Switzerland

Background

Anti-TNFalpha agents are commonly used for ulcerative colitis (UC) therapy in the event of non-response to conventional strategies or as colon-salvaging therapy. However, there are no available data on the appropriateness of treatment with biological therapies in UC. The aim was to assess the appropriateness of biological therapies for UC patients and to study treatment discontinuation over time, according to appropriateness of treatment, as a measure of outcome.

Methods

We selected adult ulcerative colitis patients from the Swiss IBD cohort who had been treated with anti-TNFalpha agents, and for whom dates of treatment were available. Appropriateness of the first-line anti-TNFalpha treatment was assessed using detailed criteria developed during the European Panel on the Appropriateness of Therapy for UC. Treatment discontinuation as an outcome was assessed for categories of appropriateness.

Results

Appropriateness of the first-line biological treatment was determined in 186 UC patients. For 64% of the patients, the use of biological treatment was considered appropriate. During follow-up, 37% of all patients discontinued biological treatment, 17% specifically because of treatment failure. Time-to-failure of treatment was significantly different among patients on an appropriate biological treatment compared to those for whom the treatment was considered not appropriate (p = 0.0007). Discontinuation rate after 2 years was 26% compared to 54% between those two groups. Patients on inappropriate biological treatment were more likely to have severe disease, concomitant steroids and/or immunomodulators. They were also consistently more likely to suffer a failure of efficacy and to cease therapy during follow-up.

Conclusion

Appropriateness of first-line anti-TNFalpha therapy results in a greater likelihood of continuing with the therapy. In situations where biological treatment is uncertain or inappropriate, physicians should consider other options instead of prescribing anti-TNFalpha agents.