PTH-071 Indicators of Suboptimal Therapy Among Crohn’s Disease Patients Treated with Tumour Necrosis Factor Antagonists: Results from A Multi-National Study

Abstract

Introduction Crohn’s disease (CD) patients treated with tumour necrosis factor antagonists (anti-TNFs) may require therapy changes over time, which may be considered as indicators of suboptimal therapy. Methods A multi-national, multicentre, retrospective, chart review study was conducted to assess the indicators of suboptimal therapy among adult CD patients receiving their first anti-TNF [infliximab (IFX) or adalimumab (ADA)] between June 2009 and June 2011 (index therapy). The indicators of suboptimal therapy during 2 year follow up were: anti-TNF dose-escalation (assessed >4 months after index to allow for initial dose adjustments), augmentation with a non-biologic drug, discontinuation of first anti-TNF, switching to another anti-TNF and CD-related surgery. The percentages of patients with each indicator type and ≥1 indicator by country for each anti-TNF drug are summarised descriptively. Results The study included 657 CD patients with mean age (SD) of 39.2 (13.2) years, 51% females, 51% with moderate to severe CD at index, 44% and 56% on ADA and IFX, respectively and 71% on combination therapy with a non-biologic drug. Overall, 56% of CD patients had ≥1 indicator of suboptimal therapy, 20% of patients had dose escalation, 18% needed augmentation with a non-biologic, 29% discontinued first anti-TNF, and 17% underwent a CD-related surgery. Of those who discontinued (N = 183), 70% switched to another anti-TNF. Conclusion In this large multi-national cohort, over half of the CD patients had ≥1 indicator of anti-TNF suboptimal therapy. Predominant indicators included dose escalation, discontinuation and switching to another anti-TNF. Disclosure of Interest A. Armuzzi Grant/research support from: MSD, Consultant for: Abbvie, Hospira, Liily, MSD, Mundipharma, Pfizer, Sofar, Takeda, Speaker bureau with: Abbvie, Astra-Zeneca, Chiesi, Ferring, Hospira, MSD, Otsuka, Takeda, Zambon, J. Lindsay Grant/research support from: MSD, Abbvie, Hospira, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Vifor Pharma, Atlantic Health care, Actavis (Warner Chilcott), and Tillotts, Consultant for: MSD, Abbvie, Hospira, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Vifor Pharma, Atlantic Health care, Actavis (Warner Chilcott), and Tillotts, Speaker bureau with: MSD, Abbvie, Hospira, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Vifor Pharma, Atlantic Health care, Actavis (Warner Chilcott), and Tillotts, R. Mody Employee of: Takeda Pharmaceuticals International, Inc, B. Bokemeyer Grant/research support from: Abbvie, Ferring, UCB, Consultant for: Abbvie, MSD, Shire, Ferring, UCB, Hospira, Takeda, Movetis, Speaker bureau with: Abbvie, Ferring, MSD, Merckle, Falk, HLR, UCB, J. Gisbert Grant/research support from: MSD, Abbvie, Hospira, Kern Pharma, Takeda, Janssen, Pfizer, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, Vifor Pharma, Consultant for: MSD, Abbvie, Hospira, Kern Pharma, Takeda, Janssen, Pfizer, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, Vifor Pharma, Speaker bureau with: MSD, Abbvie, Hospira, Kern Pharma, Takeda, Janssen, Pfizer, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, Vifor Pharma, L. Peyrin-Biroulet Consultant for: Abbvie, MSD, Jansse, Takeda, Hospira, Celltrion, Biogaran, Speaker bureau with: Abbvie, MSD, Janssen, Takeda, Mitsubishi, G. Nguyen Consultant for: Janssen and Abbvie, J. Siebenaler Conflict with: Employee of Mapi, a company hired to conduct the study by Takeda Pharmaceuticals International, Inc., O. Akerborg Conflict with: Employee of Mapi, a company hired to conduct the study by Takeda Pharmaceuticals International, Inc., M. Smyth Employee of: Takeda Development Centre Europe Ltd, London, UK