P0856 Reasons for switching subcutaneous and oral advanced therapies for IBD: a single-centre experience

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Abstract Background The evolution of biologic and small molecule treatments has revolutionised the management of patients with IBD. Yet, a proportion of patients require switching therapy. Switching therapy places high demand on healthcare resource, limits future treatment options and can induce anxiety for patients. The purpose of this study was to explore and quantify the reasons for switching therapy and determine which drugs (and drug classes) were associated with more frequent switches. Methods Observational data was obtained from a database of prescriptions for people with IBD who had their therapy switched within Swansea Bay University Health Board. Study period: 30/1/2022 to 20/9/2024 (964 days). Total no. patients 339. Total no. prescriptions 1104 (adalimumab 487; ustekinumab 333; upadacitinib 106; vedolizumab 78; tofacitinib 47; infliximab 44; filgotinib 8; risankinumab 1). Number drug switches 73 (25 male, 48 female; 32 with Ulcerative Colitis, 41 with Crohn’s Disease; average age 39.5 years). Results In terms of absolute numbers, the 5 most common reasons for switching were: secondary loss of response, biosimilar switching, primary loss of response, adverse drug reactions and development of antibodies. The 5 most common drug class switches were: Anti-TNF → Anti-TNF (biosimilar switches), Anti-TNF → IL-12/23i, IL-12/23i → JAKi, Anti-TNF → JAKi, JAKi → JAKi. The average no. days on drug was greatest for adalimumab, vedolizumab and ustekinumab respectively. Conclusion Secondary loss of response was greatest for adalimumab (9 switches, 1.8% of total ADA prescriptions) and ustekinumab (10 switches, 3.0% of total UST prescriptions). Primary loss of response was greatest for ustekinumab (4 switches, 1.2% of total UST prescriptions) and adalimumab (3 switches, 0.6% of total ADA prescriptions). These data are expected because these drugs are prescribed more frequently, and typically before other therapies are used. We do not routinely check anti-drug antibodies for vedolizumab nor ustekinumab hence only adalimumab was associated with development of antibodies. After biosimilar switches, switching between drug classes was more common than intra-class switches. Of all prescriptions (n=1104), adalimumab was prescribed for the greatest average no. days (1024 days) followed by vedolizumab (693 days) and ustekinumab (599 days). This supports the continued prescription of anti-TNF drugs which constitute a major part of our therapeutic arsenal despite the emergence of novel therapies. Prescribing data can provide insights into the reasons for switching advanced therapies in the treatment of IBD. The longevity of advanced treatments needs to be considered alongside therapy costs when developing drug formularies and treatment pathways.