Background: The treatment of Crohn’s disease has expanded with the development of biologics with different mechanisms of action. Ustekinumab, an inhibitor of IL-23, was approved for use in patients with Crohn’s Disease (CD) in September 2016. We were interested in the sequencing of biologic agents before and after the approval of ustekinumab in CD. 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 12 wks. 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 demographics and attitudinal survey responses. Results: Since the introduction of ustekinumab switching between anti-Tumor Necrosis Factor (TNF) agents has significantly decreased from 75% in 2016 to 59% in 2017 and switches from a TNF to vedolizumab significantly decreased from 21% to 14% (Fig 1). Ustekinumab accounted for 19% of the switches among the audited CD patients (Fig 1). 86% of recent switches involved patients moving from their first-line to their second-line biologic agent. Ustekinumab accounted for 21% of the first biologic switch patients compared to 13% for vedolizumab (21% in 2016). Of the patients switched to ustekinumab the treating physician noted that they would have used vedolizumab in 42% of cases and a TNF in 58% of cases had ustekinumab not been available. Conclusion: Though TNF inhibitors remain the predominant mechanism of action in CD, ustekinumab has been quickly adopted, accounting for approximately one in five recently switched patients. Among recently switched CD patients, use of both TNF inhibitors and vedolizumab has decreased as a result of the introduction of ustekinumab.
