A175 REAL-WORLD EXPERIENCE ON SWITCHING FROM ADALIMUMAB TO BIOSIMILARS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE – AN OBSERVATIONAL STUDY FROM THREE TERTIARY CARE CENTRES

Background

Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition of the bowel which includes ulcerative colitis (UC), Crohn’s disease (CD) or unspecific IBD (IBDu). Adalimumab (ADA), a humanized monoclonal IgG antibody against tumour necrosis factor-alpha (TNFa), is an effective treatment for IBD. Humira^TM is an anti-TNFa agent that was approved by Health Canada for the treatment of IBD. In May of 2019, the British Columbia government pharmaceutical benefit plan implemented a biosimilar initiative in May 2019, mandating a non-medical switch from Humira^TM to one of the biosimilar drugs.

Purpose

We aimed to evaluate the real-world experience on the comparative safety and effectiveness of adalimumab biosimilar therapy after a mandatory, non-medical switch.

Method

We performed a retrospective chart review of all patients with IBD who either remained on Humira^TM or were switched to an adalimumab biosimilar agent, Idacio, at three tertiary care centres. Patients’ demographic data, disease status including CRP and fecal calprotectin before and after switch, and hospital visits or admission after switch were collected. Statistical analysis was performed using ANOVA and t-test.

Result(s)

Of the 191 patients included in the study, 145 patients underwent the provincial mandated switch from Humira^TM to a biosimilar agent, Idacio® , whereas 46 patients remained on Humira^TM. The median age at IBD diagnosis was 27 years (range 3-76 years), and at biosimilar switch was 43.5 years (15-78 years). Median disease duration prior to biosimilar switch was 13.5 years (range 0-69 years). 55.1% of patients were male, and 12.9% of patients were active smokers. CD was found in 78.9% of patients, and 19.9% of patients had UC. After biosimilar switch, adverse events, such as rash, nausea, or vomiting, were noted in 10 patients in the biosimilar group, and 7 patients required switch back to Humira^TM. All patients in the Humira^TM group stayed on that therapy. One patient stopped the biosimilar agent due to development of a new cancer requiring chemotherapy. None of the patients required IBD-related emergency department visit or hospital admission. Additionally, there was no difference in CRP or fecal calprotectin values measured before and after the biosimilar switch, and when compared to the patients who stayed on Humira^TM (p=0.48, and p=0.142, respectively).

Conclusion(s)

We conclude that the clinical benefit of Humira^TM was sustained after a non-medical switch to an adalimumab biosimilar. There was no risk of relapse, emergency visit, or hospital admission seen in this study. This is the first Canadian study to establish the safety and efficacy of switch to non-medical switch to an adalimumab biosimilar agent.

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Disclosure of Interest

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A175 BEHAVIORAL INTERVENTIONS TO ADDRESS INFLAMMATORY BOWEL DISEASE-RELATED DISTRESS AND QUALITY OF LIFE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Inflammatory bowel disease-associated psychological distress (IBD-PD) (inclusive of anxiety, depression, and high levels of stress) is prevalent amongst persons living with IBD. IBD-PD impairs quality of life (QoL) and worsens disease outcomes. Research relating to the efficacy of behavioral interventions for IBD-PD has been limited.

Aims

This systematic review and meta-analysis was conducted to evaluate the efficacy of cognitive behavioral therapy (CBT)-based interventions for the management of IBD-PD and QoL in persons living with IBD.

Methods

Pre-defined criteria were used to identify randomized controlled studies reporting on the efficacy of CBT-based interventions for IBD-PD and QoL in adults living with IBD. Electronic databases including CINAHL, Cochrane Library, Embase, MEDLINE, PsycArticles, PsycInfo, Pubmed, and Web of Science were searched from inception to May 30, 2020. Studies published in English or French were included. Risk of bias was assessed using the Cochrane risk-of-bias tool by two independent reviewers (CH and MRF). Data was extracted and summarized qualitatively. A random-effects model was used to generate pooled estimates.

Results

Eight studies (922 participants) met criteria for inclusion in this review. The studies evaluated outcomes of quality of life and IBD-PD using the IBD Questionnaire (IBDQ), United Kingdom IBDQ, Short IBSQ, 36-Item Short Form Survey (SF-36), Short Health Scale, Perceived Stress Questionnaire (PSQ), Perceived Stress Scale (PSS-10), Hospital anxiety depression scale (HADS) and the Depression, Anxiety and Stress Scale-21 Items (DASS-21). Of the 8 studies, 2 were low, 2 high, and 4 at intermediate risk of bias. Interventions, duration, and outcome assessments differed across studies and observed attrition rates were high. The pooled odds ratio for the short-term impact of CBT on IBDQ (n=3) was 0.30 (95% CI 0.17- 0.44) favoring CBT. Perceived stress (PSQ and PSS-10) were only reported in 3 studies as secondary outcomes. Overall, CBT had no observed benefit for perceived stress. Measurement of anxiety and depression was inconsistent across studies. The impact of CBT on anxiety and depression varied with studies revealing both neutral and positive results.

Conclusions

In patients IBD-PD, CBT-based interventions were observed to lead to short-term improvements in disease-related QoL. The impact of CBT on IBD-PD remains unclear due to limitations in study quality and heterogeneity in study design. Further studies are needed to evaluate the efficacy of CBT-based interventions for IBD-PD and to define the role of behavioral interventions delivered within the context of collaborative, biopsychosocial models of care. Expert consensus on best practice for CBT-based interventions and IBD-PD evaluation are needed.

Funding Agencies

None