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Casanova MJ, Nantes Ó, Varela P, Vela-González M, Rivero M, Sierra-Gabarda O, Riestra S, Acosta MBD, Del Mar Martín-Rodríguez M, Gargallo-Puyuelo CJ, Reygosa C, Muñoz R, de la Filia-Molina IG, Núñez-Ortiz A, Kolle L, Calafat M, Huguet JM, Iglesias-Flores E, Martínez-Pérez TDJ, Bosch O, Duque-Alcorta JM, Frago-Larramona S, Van Domselaar M, González-Cosano VM, Bujanda L, Rubio S, Mancebo A, Castro B, García-López S, de Francisco R, Nieto-García L, Laredo V, Gutiérrez-Casbas A, Mesonero F, Leo-Carnerero E, Cañete F, Ruiz L, Gros B, Del Moral-Martínez M, Rodríguez C, Chaparro M, Gisbert JP. Real-world outcomes of switching from adalimumab originator to adalimumab biosimilar in patients with inflammatory bowel disease: The ADA-SWITCH study. Aliment Pharmacol Ther 2023. [PMID: 37089065 DOI: 10.1111/apt.17525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/18/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND AIMS Data on the outcomes after switching from adalimumab (ADA) originator to ADA biosimilar are limited. The aim was to compare the treatment persistence, clinical efficacy, and safety outcomes in inflammatory bowel disease patients who maintained ADA originator vs. those who switched to ADA biosimilar. METHODS Patients receiving ADA originator who were in clinical remission at standard dose of ADA originator were included. Patients who maintained ADA originator formed the non-switch cohort (NSC), and those who switched to different ADA biosimilars constituted the switch cohort (SC). Clinical remission was defined as a Harvey-Bradshaw index ≤4 in Crohn's disease and a partial Mayo score ≤2 in ulcerative colitis. To control possible confounding effects on treatment discontinuation, an inverse probability treatment weighted proportional hazard Cox regression was performed. RESULTS Five hundred and twenty-four patients were included: 211 in the SC and 313 in the NSC. The median follow-up was 13 months in the SC and 24 months in the NSC (p < 0.001). The incidence rate of ADA discontinuation was 8% and 7% per patient-year in the SC and in the NSC, respectively (p > 0.05). In the multivariate analysis, switching from ADA originator to ADA biosimilar was not associated with therapy discontinuation. The incidence rate of relapse was 8% per patient-year in the SC and 6% per patient-year in the NSC (p > 0.05). Six percent of the patients had adverse events in the SC vs. 5% in the NSC (p > 0.05). CONCLUSION Switching to ADA biosimilar did not impair patients' outcomes in comparison with maintaining on the originator.
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Affiliation(s)
- María José Casanova
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Óscar Nantes
- Gastroenterology Department, Hospital Universitario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Pilar Varela
- Gastroenterology Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Milagros Vela-González
- Gastroenterology Department, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Montserrat Rivero
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | | | - Sabino Riestra
- Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Manuel Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Carla Jerusalén Gargallo-Puyuelo
- Gastroenterology Department, Hospital Clínico Lozano Blesa, Instituto de Investigación Sanitaria Aragón (IIS Aragón), y CIBEREHD, Zaragoza, Spain
| | - Cristina Reygosa
- Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain
| | - Roser Muñoz
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), y CIBEREHD, Alicante, Spain
| | | | - Andrea Núñez-Ortiz
- Gastroenterology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Lilyan Kolle
- Gastroenterology Department, Hospital General de La Palma, Santa Cruz de Tenerife, Spain
| | - Margalida Calafat
- Gastroenterology Department, Hospital Universitario Germans Trias i Pujol, y CIBEREHD, Badalona, Spain
| | - José María Huguet
- Gastroenterology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Eva Iglesias-Flores
- Gastroenterology Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - Orencio Bosch
- Gastroenterology Department, Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | | | - Luis Bujanda
- Gastroenterology Department, Hospital Universitario de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), y CIBEREHD, Donostia, Spain
| | - Saioa Rubio
- Gastroenterology Department, Hospital Universitario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Alejo Mancebo
- Gastroenterology Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Beatriz Castro
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | | | - Ruth de Francisco
- Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Laura Nieto-García
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Viviana Laredo
- Gastroenterology Department, Hospital Clínico Lozano Blesa, Instituto de Investigación Sanitaria Aragón (IIS Aragón), y CIBEREHD, Zaragoza, Spain
| | - Ana Gutiérrez-Casbas
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), y CIBEREHD, Alicante, Spain
| | - Francisco Mesonero
- Gastroenterology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Eduardo Leo-Carnerero
- Gastroenterology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Fiorella Cañete
- Gastroenterology Department, Hospital Universitario Germans Trias i Pujol, y CIBEREHD, Badalona, Spain
| | - Lucía Ruiz
- Gastroenterology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Beatriz Gros
- Gastroenterology Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - Cristina Rodríguez
- Gastroenterology Department, Hospital Universitario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - María Chaparro
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Rodríguez-Lago I, Hoyo JD, Pérez-Girbés A, Garrido-Marín A, Casanova MJ, Chaparro M, Fernández-Clotet A, Castro-Poceiro J, García MJ, Sánchez S, Ferreiro-Iglesias R, Bastón I, Piqueras M, Careda LEIBD, Mena R, Suárez C, Cordón JP, López-García A, Márquez L, Arroyo M, Alfambra E, Sierra M, Cano N, Delgado-Guillena P, Morales-Alvarado V, Aparicio JC, Guerra I, Aulló C, Merino O, Arranz L, Hidalgo MA, Llaó J, Plaza R, Molina G, Torres P, Pérez-Galindo P, Romero MG, Herrera-deGuise C, Armesto E, Mesonero F, Frago-Larramona S, Benítez JM, Calvo M, Martín MDCL, Elorza A, Larena A, Peña E, Rodríguez-Grau MDC, Miguel-Criado JD, Botella B, Olmos JA, López L, Aguirre U, Gisbert JP. Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease. United European Gastroenterol J 2020; 8:1056-1066. [PMID: 32723069 DOI: 10.1177/2050640620947579] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn's disease. AIM The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn's disease complicated with symptomatic strictures. METHODS In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn's disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up. RESULTS Overall, 262 patients with Crohn's disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab (N = 141, 54%) or adalimumab (N = 121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19-85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn's disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18-2.22; and HR 1.55, 95% CI 1.1-2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness. CONCLUSIONS Anti-TNF agents are effective in approximately a quarter of patients with Crohn's disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting.
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Affiliation(s)
- Iago Rodríguez-Lago
- Hospital de Galdakao, Gastroenterology, Galdakao, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Javier Del Hoyo
- Hospital Universitari i Politècnic de La Fe, Gastroenterology, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | | | - María José Casanova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Hospital Universitario de La Princesa, Gastroenterology, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Hospital Universitario de La Princesa, Gastroenterology, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Agnès Fernández-Clotet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Hospital Clinic, Gastroenterology, Barcelona, Spain
| | | | - María José García
- Hospital Universitario Marqués de Valdecilla, Gastroenterology, Santander, Spain
| | - Sara Sánchez
- Hospital Universitario Marqués de Valdecilla, Radiology, Santander, Spain
| | - Rocío Ferreiro-Iglesias
- Hospital Clínico Universitario de Santiago de Compostela, Gastroenterology, Santiago de Compostela, Spain
| | - Iria Bastón
- Hospital Clínico Universitario de Santiago de Compostela, Gastroenterology, Santiago de Compostela, Spain
| | - Marta Piqueras
- Consorci Sanitari de Terrassa, Gastroenterology, Terrassa, Spain
| | | | - Raquel Mena
- Consorci Sanitari de Terrassa, Gastroenterology, Terrassa, Spain
| | - Cristina Suárez
- Hospital Universitario La Paz, Gastroenterology, Madrid, Spain
| | | | - Alicia López-García
- Hospital del Mar, Gastroenterology, Barcelona, Spain, and Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Lucía Márquez
- Hospital del Mar, Gastroenterology, Barcelona, Spain, and Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Maite Arroyo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,IIS Aragón, Hospital Clínico Universitario Lozano Blesa, Gastroenterology, Zaragoza, Spain
| | - Erika Alfambra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,IIS Aragón, Hospital Clínico Universitario Lozano Blesa, Gastroenterology, Zaragoza, Spain
| | - Mónica Sierra
- Complejo Asistencial Universitario de León, Gastroenterology, León, Spain
| | - Noelia Cano
- Complejo Asistencial Universitario de León, Gastroenterology, León, Spain
| | | | | | | | - Iván Guerra
- Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain, and Instituto de Investigación de La Paz (IdiPaz), Madrid, Spain
| | - Carolina Aulló
- Hospital Universitario de Fuenlabrada, Radiology, Fuenlabrada, Spain
| | - Olga Merino
- Hospital Universitario de Cruces, Gastroenterology, Barakaldo, Spain
| | - Laura Arranz
- Hospital Ntra. Sra. Candelaria, Gastroenterology, Santa Cruz de Tenerife, Spain
| | | | - Jordina Llaó
- Althaia, Xarxa Assistencial Universitària de Manresa, Gastroenterology, Manresa, Spain
| | - Rocío Plaza
- Hospital Universitario Infanta Leonor, Gastroenterology, Madrid, Spain
| | - Gema Molina
- Complejo Hospitalario Universitario de Ferrol, Gastroenterology, Ferrol, Spain
| | - Paola Torres
- Hospital Universitario German Trias I Pujol, Gastroenterology, Badalona, Spain
| | | | | | | | - Edisa Armesto
- Hospital San Agustín, Gastroenterology, Avilés, Spain
| | | | | | - José Manuel Benítez
- Hospital Universitario Reina Sofía, Gastroenterology, Córdoba, Spain.,IMIBIC, Córdoba, Spain
| | - Marta Calvo
- Hospital Puerta de Hierro, Gastroenterology, Madrid, Spain
| | | | - Ainara Elorza
- Hospital de Galdakao, Gastroenterology, Galdakao, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | | | - Elena Peña
- Hospital Royo Villanova, Gastroenterology, Zaragoza, Spain
| | | | | | - Belén Botella
- Hospital Universitario Infanta Cristina, Gastroenterology, Parla, Spain
| | - José Antonio Olmos
- Hospital Universitario Rey Juan Carlos, Gastroenterology, Móstoles, Spain
| | - Laura López
- Hospital Universitari Sant Joan de Reus, Gastroenterology, Reus, Spain
| | - Urko Aguirre
- Research Unit, Hospital de Galdakao. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Hospital Universitario de La Princesa, Gastroenterology, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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