Document resource
Information is limited about biologics switching pattern in children and young people (age <= 18 years) with inflammatory bowel disease (IBD) in an era of many biologics therapies. The best choice of biologic to use if the first biological infliximab is not beneficial is also unclear. This retrospective observational cohort study aimed to quantify and describe biologics switching patterns in children and young people with IBD, and to compare the effectiveness of using a second tumor necrosis factor inhibitor (TNFi) versus non-TNF failure of a first biologic TNFi in routine clinical practice.Patients with two or more successive biologic switches were identified. Biologic treatment sequence was analyzed descriptively. Baseline demographic and clinical characteristics were collected retrospectively from the electronic medical records. Treatment failure was defined as the composite of IBD related hospitalization, new prescriptions of oral/IV corticosteroids or any IBD related surgery or the need to switch to a third biologic agent. We compare characteristics of early switchers (<=6 months) vs late switchers (> 6 months).Total 229 patients were identified whom received tumor necrosis factor a antagonist (anti TNF a) treatment followed by another anti-TNFa treatment or Vedolizumab then Ustekinumab. Median age at diagnosis was 8 years. We found that (40%) switched to a different biologic after a median of 2 years after diagnosis. In total thirty six of total 229(15%)percent of patients received 3 or more biologics. The most common reason for switching from antiTNF was poor clinical response in (50%) followed by antibodies and one patient was switched due to difficult access. Seventy five percent were late switchers, and switched primarily due to loss of response or antibody formation.Most patients who failed vedolizumab had either ileocolonic disease, perianal disease or a combination. Median duration of vedolizumab was 1 year.3 of total 229 patients with ileocolonic fistulating phenotype showed poor response to Ustekinumab and required IBD related surgery. One patient was subsequently switched to Risankizumab (awaiting evaluation) with 1 further patient for consideration of risankizumab.Vedolizumab was the most common second line biologic regardless of phenotype; patients with ileocolonic/perianal disease showed poor response. Ustekinumab may be more suitable as second line in ileocolonic or perianal disease. Large multicentre studies will be beneficial as newer agents become available in paediatric IBD.References Liefferinckx C, Cremer A, Franchimont D. Switching biologics used in inflammatory bowel diseases: how to deal with in practice? Current Opinion in Pharmacology 2020;55:82–89. doi:https://doi.org/10.1016/j.coph.2020.10.003.Ibing S, Cho JH, Böttinger EP, Ungaro RC. Second-line biologic therapy following tumor necrosis factor antagonist failure: a real-world propensity score-weighted analysis. Clinical gastroenterology and hepatology 2023;21(10):2629–2638. doi:https://doi.org/10.1016/j.cgh.2023.01.038.Burgess CJ, Jackson R, Chalmers I, Russell RK, Hansen R, Scott G, Henderson P, Wilson DC. The inexorable increase of biologic exposure in paediatric inflammatory bowel disease: a Scottish, population-based, longitudinal study. Alimentary Pharmacology & Therapeutics 2022;56(10):1453–1459. doi:https://doi.org/10.1111/apt.17217.