Background: TNF-inhibitor(TNF) therapy was approved for use in moderately active ulcerative colitis (UC) in 2005. We were interested in studying to what extent newly approved biologics with a different mechanism of action (MOA) had on utilization. Methods: An independent market analytics firm collaborated with US gastroenterologists (n=187) to conduct a retrospective chart review of patients with either ulcerative colitis (UC) (n=475) or Crohn’s disease (CD) (n=566), who had switched from one biologic therapy to another in the prior 12wks. Gastroenterologists could submit up to seven charts. Data were collected in April 2017 and included clinical and non-clinical patient demographics, as well as physician demographic and attitudinal survey responses. Results: 75% of participating gastroenterologists reported recent changes to UC patient management, predominantly citing more aggressive use of biologics and increased use of vedolizumab. Use of infliximab as a first-line biologic in UC has decreased significantly over time (50% of first-line patients initiated > 24mths prior to study vs. 37% of patients initiated within 12mths prior to the study.) Over the same time, first-line use of adalimumab remained consistent and vedolizumab use increased slightly (0% to 7%)(Fig 1). Patients initiated on infliximab as their first-line biologic were significantly more likely to be switched to a second TNF inhibitor compared to patients initiated on adalimumab first-line (77% vs. 54%, respectively.) Use of vedolizumab as a second-line agent was twice as likely for patients initially started on adalimumab vs. those started on infliximab (37% vs. 19%, respectively.) (Fig 2) Conclusion: TNF therapy dominates biologic treatment for UC, however, vedolizumab is being used more and used earlier. Infliximab use for new patients has steadily decreased, however adalimumab use has stayed constant. Which TNF is used first appears to have an influence on subsequent treatment with vedolizumab.
