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Predictors of drug survival : A cohort study comparing anti-tumour necrosis factor agents using the Swedish inflammatory bowel disease quality register

Visuri, Isabella ; Eriksson, Carl ; Olén, Ola ; Cao, Yang ; Mårdberg, Emelie ; Grip, Olof LU ; Gustavsson, Anders ; Hjortswang, Henrik ; Karling, Pontus and Montgomery, Scott , et al. (2021) In Alimentary Pharmacology and Therapeutics 54(7). p.931-943
Abstract

Background: Whether long-term effectiveness differs between anti-tumour necrosis factor (anti-TNF) agents is unknown. Aims: To examine drug survival of first-line anti-TNF agents and identify predictors of discontinuation. To reduce channelling bias, we also compared drug survival of the second anti-TNF. Methods: Biologic-naïve patients (N = 955) recorded in the Swedish IBD Quality Register (SWIBREG) were examined. We used propensity score matching, comparing drug survival over up to three years of follow-up. Cox regression estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Results: In Crohn's disease, discontinuation because of lack/loss of response was 32% [95%CI = 26%-38%] for infliximab versus 16% [95%CI =... (More)

Background: Whether long-term effectiveness differs between anti-tumour necrosis factor (anti-TNF) agents is unknown. Aims: To examine drug survival of first-line anti-TNF agents and identify predictors of discontinuation. To reduce channelling bias, we also compared drug survival of the second anti-TNF. Methods: Biologic-naïve patients (N = 955) recorded in the Swedish IBD Quality Register (SWIBREG) were examined. We used propensity score matching, comparing drug survival over up to three years of follow-up. Cox regression estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Results: In Crohn's disease, discontinuation because of lack/loss of response was 32% [95%CI = 26%-38%] for infliximab versus 16% [95%CI = 11%-21%] for adalimumab. Infliximab [vs adalimumab; aHR = 1.96; 95%CI = 1.20-3.21] and colonic disease (L2) [vs no L2; aHR = 2.17; 95% CI = 1.26-3.75] were associated with higher discontinuation rates, whereas normalised CRP at three months [aHR = 0.40; 95% CI = 0.19‒0.81] with a lower rate. Consistently, patients who switched from adalimumab to infliximab (vs infliximab to adalimumab) had earlier discontinuation (P = 0.04). Concomitant use of immunomodulators was associated with a lower adverse drug reaction-mediated discontinuation rate [aHR = 0.46; 95% CI = 0.28-0.77], in part explained by fewer infusion reactions [aHR = 0.27; 95% CI = 0.08-0.89]. In ulcerative colitis, the probability of discontinuation because of lack/loss of response was 40% [95% CI = 33%-47%] for infliximab versus 37% [95% CI = 21%-53%] for adalimumab. Disease duration ≥10 years [aHR = 0.25; 95% CI = 0.10-0.58] and normalised CRP after three months [aHR = 0.39; 95% CI = 0.18‒0.84] were associated with lower discontinuation rates. Conclusions: Clinical characterisation of patients may aid decision-making on anti-TNF treatment. The consistently shorter drug survival for infliximab (vs adalimumab) in Crohn's disease, suggests a potential difference between the two drugs.

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Contribution to journal
publication status
published
subject
in
Alimentary Pharmacology and Therapeutics
volume
54
issue
7
pages
931 - 943
publisher
Wiley-Blackwell
external identifiers
  • pmid:34286871
  • scopus:85111428696
ISSN
0269-2813
DOI
10.1111/apt.16525
language
English
LU publication?
no
id
418d6f53-b9af-41a5-9e8a-fda095f7329f
date added to LUP
2021-08-31 11:29:08
date last changed
2024-06-29 16:28:20
@article{418d6f53-b9af-41a5-9e8a-fda095f7329f,
  abstract     = {{<p>Background: Whether long-term effectiveness differs between anti-tumour necrosis factor (anti-TNF) agents is unknown. Aims: To examine drug survival of first-line anti-TNF agents and identify predictors of discontinuation. To reduce channelling bias, we also compared drug survival of the second anti-TNF. Methods: Biologic-naïve patients (N = 955) recorded in the Swedish IBD Quality Register (SWIBREG) were examined. We used propensity score matching, comparing drug survival over up to three years of follow-up. Cox regression estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Results: In Crohn's disease, discontinuation because of lack/loss of response was 32% [95%CI = 26%-38%] for infliximab versus 16% [95%CI = 11%-21%] for adalimumab. Infliximab [vs adalimumab; aHR = 1.96; 95%CI = 1.20-3.21] and colonic disease (L2) [vs no L2; aHR = 2.17; 95% CI = 1.26-3.75] were associated with higher discontinuation rates, whereas normalised CRP at three months [aHR = 0.40; 95% CI = 0.19‒0.81] with a lower rate. Consistently, patients who switched from adalimumab to infliximab (vs infliximab to adalimumab) had earlier discontinuation (P = 0.04). Concomitant use of immunomodulators was associated with a lower adverse drug reaction-mediated discontinuation rate [aHR = 0.46; 95% CI = 0.28-0.77], in part explained by fewer infusion reactions [aHR = 0.27; 95% CI = 0.08-0.89]. In ulcerative colitis, the probability of discontinuation because of lack/loss of response was 40% [95% CI = 33%-47%] for infliximab versus 37% [95% CI = 21%-53%] for adalimumab. Disease duration ≥10 years [aHR = 0.25; 95% CI = 0.10-0.58] and normalised CRP after three months [aHR = 0.39; 95% CI = 0.18‒0.84] were associated with lower discontinuation rates. Conclusions: Clinical characterisation of patients may aid decision-making on anti-TNF treatment. The consistently shorter drug survival for infliximab (vs adalimumab) in Crohn's disease, suggests a potential difference between the two drugs.</p>}},
  author       = {{Visuri, Isabella and Eriksson, Carl and Olén, Ola and Cao, Yang and Mårdberg, Emelie and Grip, Olof and Gustavsson, Anders and Hjortswang, Henrik and Karling, Pontus and Montgomery, Scott and Myrelid, Pär and Ludvigsson, Jonas F. and Halfvarson, Jonas and Olsson, Malin and Lauber, Andree and Magnuson, Anders}},
  issn         = {{0269-2813}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{931--943}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Alimentary Pharmacology and Therapeutics}},
  title        = {{Predictors of drug survival : A cohort study comparing anti-tumour necrosis factor agents using the Swedish inflammatory bowel disease quality register}},
  url          = {{http://dx.doi.org/10.1111/apt.16525}},
  doi          = {{10.1111/apt.16525}},
  volume       = {{54}},
  year         = {{2021}},
}