A93 NO INCREASE IN IMMUNOMODULATOR USE IN COMBINATION WITH ANTI-TNF THERAPY IN THE POST SONIC ERA

The SONIC trial in 2010 definitively proved the superiority of anti tumor necrosis factor (anti-TNF) therapy in combination with thiopurines over anti-TNF monotherapy in persons with moderate to severe CD. Despite high-quality evidence supporting combination therapy, there is a scarcity of data about the impact of this trial on the utilization of combination therapy (anti-TNF plus thiopurines or methotrexate) in clinical practice. We assessed the prevalence of combination therapy usage by all Manitoba gastroenterologists both pre and post publication of the landmark SONIC trial in 2010. All 23 prescribers of anti-TNF medications for IBD in Manitoba agreed to participate in the study. Patient charts were reviewed, with demographics, disease characteristics, and prior IBD treatments recorded from time of first contact with a gastroenterologist. The pre-SONIC group was defined as persons who received their first anti TNF treatment between 2005 and 2009, and the post-SONIC group as those who started treatment between 2011 and 2015; subjects starting therapy in 2010 were excluded. The proportion of subjects using combination therapy was compared between the pre-SONIC and post-SONIC patient populations. 1,070 patients were identified, of whom 673 met the inclusion criteria. 226 patients started treatment pre SONIC and 447 post SONIC. Pre SONIC, 50.0% received combination therapy compared with 48.3% post SONIC (p=0.68). The proportion of patients receiving adalimumab increased from 12.3% in the pre-SONIC period to 33.2% post-SONIC (p<0.00001); Adalimumab users were as likely as infliximab users to receive combination therapy. Choice of immunomodulator differed pre and post SONIC. Of those who received combination therapy pre SONIC 80.0% received a thiopurine, versus 91.2% post SONIC (p=0.04). Of patients treated with anti-TNF monotherapy, 41.9% pre SONIC and 41.4% post SONIC had no record of any immunomodulator therapy before starting anti-TNF treatment (p=0.94). There were no differences in demographics, clinical characteristics, or markers of disease activity/severity between pre and post SONIC groups, or between combination therapy and anti-TNF monotherapy groups. We were unable to detect increased prevalence of combination therapy among anti-TNF users in the post-SONIC era. This represents a potential opportunity for quality improvement initiatives to optimize care of persons with IBD requiring anti-TNF based therapy. None

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