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Poster presentations: Clinical: Therapy and Observation 2020

P435 Real-world clinical outcomes after elective discontinuation of first-use biologics in IBD patients

U.N. Shivaji1, A. Bazarova2, T. Critchlow3, O.M. Nardone4, S.C. Smith4, M. Love3, J. Davis3, S. Ghosh1, M. Iacucci1

1Gastroenterology, NIHR Birmingham Biomedical Research Centre- University Hospitals Birmingham NHS Foundation Trust and University of Birmingham- UK, Birmingham, UK, 2Institute for Biological Physics, University of Cologne, Cologne, Germany, 3Gastroenterology, University Hospitals Birmingham- UK, Birmingham, UK, 4Gastroenterology, Institute of Immunology and Immunotherapy- University of Birmingham, Birmingham, UK

Background

In real-world clinical practice, biologics may be discontinued due to variety of reasons, including discontinuation by gastroenterologists, in the UK. The aim of the study was to report on outcomes after discontinuation in IBD patients after a minimum follow-up of 24 months.

Methods

All IBD patients who discontinued their first-use biologics between January 2013 and Dec 2016 were identified from the EMR at a tertiary referral centre to ensure at least 24 months follow-up. Reasons for discontinuation and pre-defined adverse outcomes (steroid and other rescue therapies, hospitalisations, surgery including perianal) were recorded. The data were analysed using multivariable and univariable logistic regressions within a machine learning technique in order to predict adverse outcomes within the stated timeframe. We performed Kaplan-Meier survival analysis for those patients who had biologics electively discontinued.

Results

In total, 147 IBD patients who discontinued biologics (M = 74.median age 39 years; CD = 110) were identified. Follow-up ranged from 24 to 60 months (median 40 months). One hundred and forty-four patients (98%) discontinued anti-TNF (1% biosimilar anti-TNF and 1% vedolizumab) and 69 (47%) were on thiopurines at start of biologics. Fifty-nine patients (40%) had biologics electively discontinued by their gastroenterologists and they were analysed separately. Of the 59 elective discontinuations, 22(37%) continued thiopurines after biologic stoppage; 37/59 (63%) patients had at least one adverse outcome (AO) within 6 months of discontinuation and 42/59 (71%) patients restarted biologics.

Figure 1. the Kaplan–Meier survival curve after elective discontinuation.

Conclusion

The majority of patients who electively discontinued biologics had IBD-related AO rapidly after the stoppage and needed to restart biologics. Almost all patients had AO by the end of the study follow-up period. This should be discussed with patients when considering discontinuation of biologics.