P4315 - Clinical Effectiveness and Response Rates to TNF Inhibitors Are Similar Among Biologic-Naïve versus Biologic-Exposed Crohn’s Disease Patients

Aaron Wong, MD, Emily Gore, MD, Ella Cohen, MD, Illya Aronskyy, MD, Ryan C. Ungaro, MD, Abhik Bhattacharya, MD
Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: In patients with Crohn’s disease (CD), biologic therapies, particularly tumor necrosis factor inhibitors (TNFi) are one of the mainstays of treatment. However, there is limited literature on whether exposure to non-TNFi biologics affects subsequent clinical response to TNFi. This study compared the effectiveness and response rates to TNFi in biologic-naive CD patients versus in those with prior exposure to non-TNFi.

Methods: This was a retrospective cohort study performed at an academic tertiary care institution. A composite primary outcome was used to assess for treatment failure or disease-related complications within 12 months of TNFi initiation. Components of the primary outcome included discontinuation of the TNFi, new steroid initiation, disease-related emergency department visits, disease-related hospitalizations, and disease-related surgeries. Additional secondary outcomes included physician global assessments and evidence of endoscopic healing.

Results: This review included 273 adult CD patients (244 biologic-naive, 29 biologic-exposed) newly initiated on a TNFi between 2016 and 2023. Baseline demographics were largely similar between both groups. There was no significant difference in composite outcome (rates of treatment failure or disease-related complications) between biologic-naive and biologic-exposed patients within 12 months (p=0.511) [Figure A]. Rates of new steroid initiation within 12 months were higher in biologic-exposed versus biologic-naive patients (OR 3.67 [1.35-9.39]; p=0.008). All other primary outcome components and secondary outcomes did not differ significantly between the groups (Table 1; Figure B).

Discussion: These results suggest that prior exposure to non-TNFi does not affect rates of TNFi treatment failure or disease-related complications in CD. Clinical decision-making surrounding IBD therapies should be individualized for each patient.



Disclosures:


Aaron Wong, MD, Emily Gore, MD, Ella Cohen, MD, Illya Aronskyy, MD, Ryan C. Ungaro, MD, Abhik Bhattacharya, MD. P4315 - Clinical Effectiveness and Response Rates to TNF Inhibitors Are Similar Among Biologic-Naïve versus Biologic-Exposed Crohn’s Disease Patients, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.