P723 Comparison of the Persistence Rates of Biologic Agents in Paediatric Crohn's Disease Patients (Japanese Paediatric IBD Registry Study)
Nishida, D.(1);Ishige, T.(2);Arai, K.(3);Shimizu, H.(3);Iwama, I.(4);Nambu, R.(4);Kunisaki, R.(1);Yaguchi, K.(1)*;Mizuochi, T.(5);Murakoshi, T.(6);Saito, T.(7);Kato, S.(8);Kudo, T.(9);Iwata, N.(10);Inoue, M.(11);Yodoshi, T.(12);Hagiwara, S.I.(13);Toita, N.(14);Tajiri, H.(15);Mochizuki, T.(16);Kakuta, F.(17);Kumagai, H.(18);Noguchi, A.(19);Sasaki, M.(20);Nishimata, S.(21);Aomatsu, T.(22);Hirano, Y.(3);Shimizu, T.(23);
(1)Yokohama City University Medical Centre, Inflammatory Bowel Disease Centre, Yokohama, Japan;(2)Gunma University, Department of Paediatrics, Maebashi, Japan;(3)National Centre for Child Health and Development, Inflammatory Bowel Disease Centre, Tokyo, Japan;(4)Saitama Children's Medical Centre, Division of Gastroenterology and Hepatology, Saitama, Japan;(5)Kurume University, Department of Pediatrics and Child Health, Kurume, Japan;(6)Tokyo Metropolitan Children's Medical Centre, Department of Gastroenterology, Tokyo, Japan;(7)Chiba University, Department of Pediatric Surgery, Chiba, Japan;(8)Shinshu University, Department of Paediatrics, Matsumoto, Japan;(9)Juntendo University, Department of Paediatrics and Adolescent Medicine, Tokyo, Japan;(10)Aichi Children's Health and Medical Centre, Department of Infection and Immunology, Ohobu, Japan;(11)Mie University, Department of Gastrointestinal and Paediatric Surgery, Tsu, Japan;(12)Okinawa Chubu Hospital, Department of Paediatrics, Okinawa, Japan;(13)Osaka Women's and Children's Hospital, Department of Gastroenterology- Nutrition and Endocrinology, Izumi, Japan;(14)Sapporo Kosei General Hospital, Department of Paediatrics, Sapporo, Japan;(15)Osaka General Medical Centre, Department of Paediatrics, Osaka, Japan;(16)Osaka Police Hospital, Department of Pediatrics, Osaka, Japan;(17)Miyagi Children's Hospital, Department of General Paediatrics and Gastroenterology, Sendai, Japan;(18)Jichi Medical University, Department of Pediatrics, Shimotuke, Japan;(19)Akita University, Department of Paediatrics, Akita, Japan;(20)Iwate Medical University, Department of Paediatrics, Morioka, Japan;(21)Tokyo Medical University, Department of Paediatrics, Tokyo, Japan;(22)Osaka Medical University, Department of Paediatrics, Takatsuki, Japan;(23)Juntendo University, Department of Pediatrics and Adolescent Medicine, Tokyo, Japan;
Biologics are widely used for paediatric Crohn's disease (CD) and are highly effective; however, primary inefficacy and the emergence of secondary inefficacy during long-term use remain challenges. Although it is desirable for biologics used in paediatric patients to be safe and usable long-term, there are few detailed reports on the comparison of persistence rates of biologics in paediatric patients.
This was a multicentre prospective cohort study using a web-based registry system in Japan that was performed between October 2012 and March 2020. New paediatric inflammatory bowel disease patients diagnosed at less than 18 years of age were enrolled from 23 Japanese hospitals. The persistence rates of the first biologics (Infliximab: IFX and Adalimumab: ADA), and the second biologics (IFX, ADA, and Ustekinumab: UST) were analysed. Patients with unknown outcomes were excluded.
We enrolled 185 patients with CD as the final diagnosis, and 109 (59%) received biologics during the observation period. As the first biologic, IFX was used in 52 (45%) patients, ADA in 52 (45%), UST and Vedolizumab (VED) in one, respectively, and the biologic in one patient was unidentified. The 1-, 3- and 5-year persistence rates of IFX and ADA as the first biologic were 90%, 70% and 61% for IFX, and 80%, 71% and 49% for ADA, respectively (Fig.1), with no statistically significant difference (P=0.31). There was also no statistically significant difference after propensity score matching (P=0.27). Multivariate analysis showed that Paris classification L4a and b were independent risk factors for lower retention of biologics in IFX and ADA. Of the 104 patients whose first biologic was IFX or ADA, 31 patients were treated with a second biologic (IFX: 7, ADA: 6, UST: 15, VED: 2 and unknown: 1). The 1- and 3-year persistence rates of the second biologic were 86% and 51% for IFX; 80% and 80% for ADA and 100% and 100% for UST, respectively (Fig.2).
The persistence rates of IFX and ADA as first biologics were similar in paediatric patients with CD, and the persistence rates of UST tended to be higher than IFX or ADA as second biologics, although the differences were not statistically significant.