A RECENT study has revealed that the sequence of biologic treatments in patients with inflammatory bowel disease (IBD) significantly affects their risk of adverse clinical outcomes. Patients with IBD, including Crohn’s disease (CD) and ulcerative colitis (UC), are at heightened risk of complications such as hospitalisation, surgery, dysplasia, colorectal cancer (CRC), and infections due to chronic inflammation.
The research, part of the ROTARY part B study, analysed patient data from the Optum® Clinical Database. It focused on patients with CD or UC who received two different biologic therapies in succession. The biologics assessed included adalimumab, infliximab, ustekinumab (for CD), and vedolizumab. The study aimed to evaluate the incidence of IBD-related complications based on the order in which biologics were administered.
In patients with CD, those who received ustekinumab followed by infliximab had the highest incidences of hospitalization (51.9%), surgery (40.7%), CRC (3.7%), and infection (37.0%). By contrast, those who received vedolizumab first, followed by an anti-TNFα treatment (like infliximab or adalimumab), experienced fewer adverse outcomes, including a lower risk of hospitalization, surgery, and infections. Specifically, this treatment sequence showed a 1.5-fold reduced risk compared to two successive anti-TNFα treatments.
For UC patients, the combination of vedolizumab followed by adalimumab resulted in the lowest incidence of adverse outcomes, including hospitalisation (20.3%), surgery (6.3%), CRC (0%), dysplasia (0%), and infection (4.7%).
The study concludes that biologic sequencing plays a critical role in managing IBD and that vedolizumab as a first-line biologic could improve patient outcomes. These findings offer valuable guidance for clinicians in selecting treatment regimens for IBD patients, potentially reducing the risk of severe complications.
Ada Enesco, EMJ
Reference
Cleveland NK et al. Evaluation of adverse clinical outcomes in patients with inflammatory bowel disease receiving different sequences of first- and second-line biologic treatments: findings from ROTARY. BMC Gastroenterol. 2024;24(1):314.
