P105 Biologic/JAK preference in different IBD patient types

Abstract

BACKGROUND: The IBD market is rapidly evolving as new biologic and small molecule agents are being approved such as ustekinumab in Crohn's disease and tofacitinib in ulcerative colitis (UC). This study sought to understand gastroenterologists' product preferences for certain patient types and to understand any shifts in preference with new agents to consider. METHODS: Each quarter, an independent healthcare agency surveys approximately 100 US gastroenterologists about the evolving treatment of IBD. To qualify, gastroenterologists must spend the majority of time in clinical practice, must be managing a minimum of 50 patients with IBD, and must be in practice between 2 and 35 years. Regional and practice setting quotas are applied in order to obtain a representative sample. The survey is administered online and respondents are compensated for their participation. The data are collected and analyzed in SPSS. RESULTS: Gastroenterologists describe over half of their UC patients as being “young, with active lifestyles”. This patient type has historically been strongly associated with adalimumab over other biologic agents, with 64% (n = 100) of respondents surveyed in April 2018 indicating that they would be most likely to use adalimumab for this patient category. However, with the availability of tofacitinib, which was approved in June 2018, preference for this large patient segment is changing. In the July 2018 wave of the survey, nearly one-quarter (23%) of gastroenterologists selected the new, oral JAK inhibitor as their most likely agent of choice for young, active patients, with adalimumab preference dipping to 54%. Tofacitinib was also selected by 16% of the gastroenterologists as being the drug of choice in patients with secondary TNF failures (waning efficacy), though the majority still prefer vedolizumab in this scenario (58%). When directly comparing adalimumab with tofacitinib in UC, gastroenterologists view adalimumab outperforming tofacitinib on all attributes associated with length of time in the market, but tofacitinib is already matching, or outpacing, adalimumab on many key attributes for treatment success including efficacy, adherence, tolerability, and sustained response. Analysis of the most recent prescription patterns, as assessed by physician allocation of their last 5 biologic/JAK prescriptions between April 2018 and July 2018 shows declining use of adalimumab (34% to 30%) with an increase of tofacitinib (0% to 5%). CONCLUSION(S): Adalimumab has long been the preferred biologic agent for the treatment of UC in younger, active patients, relatively unchallenged by any of the other biologics for this large patient sub-type. Early use of tofacitinib suggests that the advent of an oral advanced therapy option may soon rival adalimumab for preference in younger, active patients.