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How to Choose the Biologic Therapy in a Bio-naive Patient with Inflammatory Bowel Disease.

ABSTRACT: The availability of biologic therapies in inflammatory bowel disease (IBD) is increasing significantly. This represents more options to treat patients, but also more difficulties in choosing the therapies, especially in the context of bio-naïve patients. Most evidence of safety and efficacy came from clinical trials comparing biologics with placebo, with a lack of head-to-head studies. Network meta-analysis of biologics and real-world studies have been developed to solve this problem. Despite the results of these studies, there are also other important factors to consider before choosing the biologic, such as patient preferences, comorbidities, genetics, and inflammatory markers. Given that resources are limited, another important aspect is the cost of biologic therapy, since biosimilars are widely available and have been demonstrated to be effective with a significant decrease in costs. In this review, we summarize the evidence comparing biologic therapy in both Crohn´s disease (CD) and ulcerative colitis (UC) in different clinical situations. We also briefly synthesize the evidence related to predictors of biologic response, as well as the biologic use in extraintestinal manifestations and the importance of the drug-related costs.

SUBMITTER: Laredo V

PROVIDER: S-EPMC8837085 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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How to Choose the Biologic Therapy in a Bio-naïve Patient with Inflammatory Bowel Disease.

Laredo Viviana V Gargallo-Puyuelo Carla J CJ Gomollón Fernando F

Journal of clinical medicine 20220204 3

The availability of biologic therapies in inflammatory bowel disease (IBD) is increasing significantly. This represents more options to treat patients, but also more difficulties in choosing the therapies, especially in the context of bio-naïve patients. Most evidence of safety and efficacy came from clinical trials comparing biologics with placebo, with a lack of head-to-head studies. Network meta-analysis of biologics and real-world studies have been developed to solve this problem. Despite th ...[more]

PMID: 35160280

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Project description:BackgroundReal-world assessments of biosimilars are needed to understand their effectiveness and safety in practice settings that may differ from those seen in clinical trials or healthcare systems in different countries. To assess the effectiveness and safety of a biosimilar (infliximab-dyyb) and its reference product (infliximab) in patients with inflammatory bowel disease (IBD) in the United States.MethodsWe conducted a retrospective cohort study of biologic-naive patients with IBD who started treatment with infliximab-dyyb or infliximab. The study included 3206 patients identified through electronic health records in a US integrated healthcare delivery system. The effectiveness outcome was a composite of IBD-related surgery, IBD-related emergency room visit, and IBD-related hospitalization within 12 months of initiation. Safety outcomes included incidence of any or serious infection, cancer, acute liver dysfunction, and tuberculosis. We used a non-inferiority test with an upper-limit margin of 10% to analyze effectiveness. Doubly robust methods incorporating Cox proportional hazard regression with standardized inverse probability of treatment weighting were used to analyze both effectiveness and safety outcomes.ResultsThe composite effectiveness outcome occurred in 107 of 870 patients (12.3%) in the infliximab-dyyb and 379 of 2336 patients (16.2%) in the infliximab groups. Infliximab-dyyb was non-inferior (P < .01) and was not different (hazard ratio [HR] 0.81; confidence interval [CI] 0.65-1.01; P = .06) to infliximab. Safety outcomes were not different between infliximab-dyyb and infliximab for any infections (HR 1.01; CI 0.86-1.17; P = .95), serious infections (HR 0.83; CI 0.54-1.26; P = .38), cancers (HR 0.83; CI 0.44-1.54; P = .55), and tuberculosis (HR 0.59; CI 0.10-3.55; P = .57).ConclusionsInitiation of infliximab-dyyb was non-inferior to infliximab among biologic-naive patients with IBD in an US integrated healthcare delivery system.

Project description:OBJECTIVES/SPECIFIC AIMS: Inflammatory Bowel Disease (IBD) is a chronic, life-long condition characterized by inflammation of the intestine that greatly affects an individual’s quality of life. While biologic therapy directed against TNFα (anti-TNFα, Infliximab) and α4β7 integrin (anti-α4β7; Vedolizumab) is used to treat IBD, a substantial number of patients remain non-responsive. Using a comprehensive bioinformatics approach, the aim of this study was to characterize immune cell profiles and altered molecular pathways in IBD patient non-responders to anti-TNFα and anti-α4β7 therapy to determine potential mechanisms and/or indicators of treatment non-response. METHODS/STUDY POPULATION: Publicly available whole transcriptomes from 65 healthy control and IBD endoscopic biopsies were assessed (NCBI GEO GSE73661). Specifically, transcript profiles from responders or non-responders to anti-TNFα and anti-α4β7 therapy were utilized. Differentially expressed transcript profiles were obtained by comparing responders or non-responders prior to receiving therapy versus healthy controls using NCBI’s GEO2R after adjustment with Benjamini and Hochberg testing (p<0.05). Immune profiling of DEgs were analyzed by the core LM22 immune signature for subsets of B-, T-, dendritic-, mast-cells, macrophages, and neutrophils (CIBERSORT, cibersort.stanford.edu) (p<0.05). Networks, functional analysis, and interpretation of transcriptomic data were performed using Ingenuity Pathway Analysis (IPA) (Qiagen) (p<0.05). RESULTS/ANTICIPATED RESULTS: Initially, we determined colonic immune profiles in responders and non-responders to anti-TNFα and anti-α4β7 therapy. Compared to responders, in both anti-TNFα and anti-α4β7 non-responders we found elevated neutrophil levels (p<0.05). Specific to anti-TNFα treatment, non-responders demonstrated substantially reduced Treg cells (p<0.05); whereas, exclusive to anti-α4β7 treatment, non-responders showed elevated dendritic cells, activated CD4 T cells, and reduced M2 macrophages (p<0.05). Next we profiled differentially expressed transcripts to determine molecular pathways associated with therapy non-response. In both anti-TNFα and anti-α4β7 non-responders, we observed alterations in pathways specific to cellular growth and metabolism. Among cell growth pathways we found activated growth hormone, Wnt, ErB, and IGF-1 signaling; whereas, among metabolic regulation we found altered triglyceride, tryptophan, and leptin signaling. Moreover, unique to anti-TNFα non-responders, we found activated sphinogosine-1-phosphate and paxillin pathways. While non-response to anti-α4β7 indicated activation of SAPK/JNK and IL-9 signaling. DISCUSSION/SIGNIFICANCE OF IMPACT: Together these data define specific immune profiles and molecular pathways observed in non-responders to anti-TNFα and anti-α4β7 therapy. Our analysis identified substantial alterations in pathways specific to cellular growth and metabolism, identifying a link between non-response to biologic therapy and specific cell functions. These data suggest particular alterations in immune profiles and molecular pathways could play a role in non-response to biologic therapy, highlighting a future direction for personalized treatment regimens that could lead to more targeted use of existing therapies and more favorable patient health outcomes.

Dataset Information

How to Choose the Biologic Therapy in a Bio-naive Patient with Inflammatory Bowel Disease.

Publications

How to Choose the Biologic Therapy in a Bio-naïve Patient with Inflammatory Bowel Disease.

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