Remission Status and Reasons for Treatment Switching in Patients With Crohn’s Disease by Treatment Line: A Real-World Study in Europe and the United States of America
AIBD 2023
Background:
Although biologic therapies have significantly advanced disease management in patients with Crohn’s disease (CD), not all patients with CD are able to achieve disease remission. This real-world study aimed to describe the proportion of patients achieving remission based on their biologic treatment line and the main reasons for treatment switch.
Methods:
Data were drawn from the Adelphi Real World CD Disease Specific Programme™, a cross-sectional survey with retrospective data collection of gastroenterologists and their consulting patients with CD in France, Germany, Italy, Spain, the United Kingdom, and the United States of America from January 2020 to March 2021. Gastroenterologists reported data on patient demographics, treatment history, reasons for treatment switch, remission status, remission duration, and components of the Harvey Bradshaw Index (HBI). HBI scores were derived for all patients. Two definitions of remission were considered: a HBI score of < 5 or gastroenterologist-assessed remission (clinical/symptomatic remission and/or full mucosal healing achieved). Patients who had been receiving their current biologic treatment for ≥2 months at time of data collection with known treatment history were grouped based on the number of biologic lines received since diagnosis; 1st line (1L), 2nd line (2L) or 3rd+ line (3L+). Descriptive statistics were reported.
Results:
Records for a total of 1,118 patients (1L n=847, 2L n=201, 3L+ n=70) were analyzed. Patients in the 1L, 2L and 3L+ groups had mean (standard deviation; SD) age of 37.8 (13.2), 40.5 (12.7), and 41.4 (13.0) years, respectively, and 51.7%, 53.7%, and 54.3% were male. Median (interquartile range; IQR) disease duration was 2.7 (1.3 – 5.0), 5.6 (3.6 – 9.5), and 7.7 (4.8 – 12.5) years, respectively. Patients in the 1L, 2L and 3L+ groups had been receiving current treatment for a median (IQR) of 65.9 (38.9 – 131.1), 64.0 (36.6 – 112.4), and 57.4 (29.4 – 94.5) weeks, respectively when remission status was assessed. According to gastroenterologist assessment, 81.3% of 1L, 72.1% of 2L, and 58.6% of 3L+ patients had achieved remission for a median (IQR) of 39.0 (17.0 – 65.0), 52.0 (26.0 – 104.0), and 26.0 (17.0 – 52.0) weeks, respectively. Based on HBI, 76.9% of 1L, 67.2% of 2L, and 52.9% of 3L+ patients were in remission. Among 2L and 3L+ patients, the most common overall reasons for switch from previous to current treatment were loss of response over time (49.1%), disease progression (33.6%), lack of flare control (22.9%), remission not maintained with previous treatment (19.9%), and remission not induced with previous treatment (17.7%).
Conclusions:
This analysis shows a considerable proportion of patients with CD had not achieved remission on their current biologic treatment. Regardless of the remission definition used, the proportion of patients achieving remission decreased at later treatment lines. The most common reason for treatment switching was loss of response to treatment over time. These findings highlight the need for effective and safe treatment options earlier in the treatment pathway.
