A159 ANTI-TUMOR NECROSIS FACTOR THERAPY PERSISTENCE IN PATIENTS WITH PERIANAL CROHN’S DISEASE AND LUMINAL CROHN’S DISEASE: A COMPARATIVE COHORT STUDY

Abstract Background Anti-tumor necrosis factor therapy has revolutionized the management of Crohn’s disease. Despite its effectiveness, a substantial proportion of patients discontinue therapy over time. Evaluating drug persistence rates reveals a real-world pattern of biologic use. Perianal Crohn’s disease (PCD) is considered one of the most difficult phenotypes of Crohn’s disease (CD) to treat. Therefore, we hypothesized that patients with PCD have a shorter biologic persistence time due to refractory disease. Aims Our aim is to compare drug persistence rates of anti-TNF therapy between PCD and LCD patients. Methods We performed a retrospective, comparative cohort study at a tertiary care center between Nov 2019 and July 2020. Patients with CD were identified by our institutional data-base, using the ICD-10 code K50.90. A longitudinal chart review determine anti-TNF utilization and classified patients based on luminal CD only [LCD] or PCD. Patients with PCD were matched (1:1) to patients with LCD based on sex, age, and year of first anti-TNF initiation within 5 years. Time to discontinuation of anti-TNF therapy was estimated by Kaplan-Meier methods and compared between groups by Log-rank test. Results A total of 142 patients with PCD (55% male, 38.7 ± 13.7 years old at anti-TNF start) were matched to 142 patients with LCD (55% male, 38.7 ± 14.0 years old at anti-TNF start). The initial treatments included infliximab (67.6% vs. 57.7%) and adalimumab (32.4% vs. 42.3%) for patients with PCD and LCD respectively. Concomitant immunomodulator were used in 61.3% of patients with PCD and 54.9% of patients with LCD. The cumulative persistence of the initial anti-TNF therapy was similar between cohorts (Log rank, p = 0.633; Figure 1): mean time to discontinuation was 27.7 ± 26.8 months for patients with PCD and 26.5 ± 23.0 months for patients with LCD. The reasons for treatment discontinuation included: refractory disease (19% vs. 16%), anti-drug antibodies (6% vs. 12%), and side effects (12.7% vs. 16.2%) in patients PCD and LCD respectively. Of the patients who discontinued their first anti-TNF therapy, 36 patients (55.4%) with PCD and 42 patients (60.9%) with LCD were treated with a second anti-TNF therapy. Discontinuation of the second-line anti-TNF therapy occurred in 18 patients (50%) with PCD and 18 patients (42.9%) with LCD: mean time to discontinuation was 17.3 ± 14.3 months and 27.8 ± 28.8 months respectively. Conclusions In this single-center, observational study a substantial percentage of patients discontinue anti-TNF therapy overtime, and there does not appear to be a difference between patients with PCD and LCD. Funding Agencies None

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