Search in the Abstract Database

Abstracts Search 2019

P331 Real-world assessment of biological treatment of inflammatory bowel disease at an Austrian Referral Centre: the ULTIMATE study

H. P. Gröchenig*1, E. Walter2, A. Redl3, M. Bresztowanszky1, K. Steidl1, F. Siebert1, G. Novacek5

1Krankenhaus der Barmherzigen Brüder, Internal Medicine, St. Veit an der Glan, Austria, 2Institute for Pharmaeconomic Research, Vienna, Austria, 3Datamedrix GmbH, Vienna, Austria, 5Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria

Background

Inflammatory bowel diseases (IBD) are characterised by a chronic or relapsing inflammation of affected gut segments leading to progressive gut damage and intestinal complications. Biologics are considered to be the most effective treatment options nowadays. However, primary nonresponse, loss of response and side effects may occur in a clinically-relevant number of patients. We analysed treatment duration and dose escalations with biologics as well as hospitalisation rates during treatment periods.

Methods

This was a retrospective single-centre cohort study at an Austrian referral IBD centre. All consecutive patients with Crohn’s disease (CD) (n = 93) or ulcerative colitis (UC) (n = 53) who initiated a biologic treatment such as TNF-α-inhibitors and vedolizumab between January 2006 October 2016 were included. Medical characteristics including details of treatment with biologics were captured from chart review. The study outcomes were treatment duration, the need for dose escalation with biologics and hospitalisation rates. We performed a descriptive analysis.

Results

The number of patients who received each treatment lines (n = 268) are presented in the table. Median duration of first, second, and 3rd line biologic treatments in CD patients were 32.2, 34.9, and 11.8 months, respectively, compared with 21.8, 19.9, and 16.6 months in UC patients. Dose escalation was required in 39.6% of all therapy lines (n = 106). This was required in 34.9% of all first-line treatments and increased numerically in subsequent lines. The dose was increased by 37.1% compared with the standard dose in all treatment lines. In patients who received over two lines, the dose increase for TNF-α-inhibitors was numerically higher compared with vedolizumab (42.3% vs. 33.9%); vedolizumab was primarily used as second and third line treatment. The hospitalisation rate rose numerically with the number of treatment lines.

Treatment linesAdalimumabInfliximabVedolizumabGolimumabOtherTotal
First line73 (59/14)61 (32/29)6 (1/5)6 (1/5)146 (93/53)
Second line26 (18/8)20 (14/6)26 (12/14)3 (1/2)3 (2/1)78 (47/31)
Third line1 (0/1)6 (4/2)16 (9/7)2 (2/0)2 (1/1)27 (16/11)
Fourth line3 (3/0)3 (3/0)5 (3/2)3 (2/1)14 (11/3)
Fifth line1 (1/0)2 (2/0)3 (3/0)
Total100 (77/23)90 (53/37)51 (25/26)17 (8/9)10 (7/3)268 (170/98)

Description of analysed treatment lines after conventional treatment of CED patients (CD/UC).

Conclusion

The duration of first and second biologic treatment lines were both nearly 3 years for CD and nearly 2 years for UC, respectively, and decreased with subsequent treatment lines. Overall, approximately 40% of all IBD patients needed dose escalation of their biologic treatment. The hospitalisation rate increased with the number of treatment lines.