The following is a summary of “Biological Agents in the Treatment of Crohn’s Disease: A Propensity Score–Matched Analysis From the Prospective Persistence Australian National IBD Cohort (PANIC3) Study,” published in the August 2024 issue of Gastroenterology by Chetwood et al.

Comparative effectiveness research on Crohn’s disease (CD) lacks head-to-head studies between advanced therapies and long-term follow-up.

Researchers conducted a retrospective study determining the best sequencing and positioning of biological agents for CD based on real-world treatment persistence.

They analyzed data from the Australian National Pharmaceutical Benefits Scheme registry (2005–2019) for CD. The analysis found no required prescribing order for biological agents, allowing treatment access to all citizens and permanent residents, regardless of insurance status. To minimize selection bias, propensity score matching was applied.

The results showed 2,029 therapy lines across 1,446 patients (median age 43 years, IQR 34–58, 44% male) over 15 years, with 5,618 patient-years of follow-up. Of these, 915 (45.1%) used adalimumab, 722 (35.6%) used infliximab, 155 (7.6%) used vedolizumab, and 237 (11.7%) used ustekinumab. No differences in persistence were found among biological agent-naive patients (P>0.05). For biological agent-experienced CD, ustekinumab showed significantly better persistence compared to non-ustekinumab agents (P=0.0018), anti-tumor necrosis factor (TNF) alpha therapies (P=0.006), or vedolizumab (P<0.001). Ustekinumab’s persistence was unaffected by prior biological agent use (P=0.51). Post-anti-TNF therapy, ustekinumab persisted better than another anti-TNF agent (P=0.033) and vedolizumab (P=0.026). Propensity score matching, adjusting for age, immunomodulator use, and bio-exposed status, demonstrated ustekinumab’s superior persistence over anti-TNF therapies (P=0.01). Multivariate analysis identified the use of non-ustekinumab biological agents (aHR 2.10, P<0.001) and bio-experienced status (aHR 1.23, P<0.001) as predictors of worse persistence.

Investigators concluded that an extensive national prospective database did not identify superior persistence of any biological agent in bio-naive CD. Still, ustekinumab was associated with greater persistence in bio-experienced patients.

Source: journals.lww.com/ajg/abstract/2024/08000/biological_agents_in_the_treatment_of_crohn_s.18.aspx