Description of real-world treatment patterns of advanced therapies for Inflammatory Bowel Disease in Portugal

Abstract

Inflammatory bowel disease (IBD) is a complex immunologic condition. Biological therapies are the key to managing moderate to severe IBD in patients who fail or are intolerant to conventional treatment. There are some patients for whom, to maintain an appropriate response, it is necessary to adjust the frequency of the therapies for each patient compared to what is approved or recommended in the summary of product characteristics.
The goal of this study was to describe real-world treatment patterns of advanced therapies for IBD in Portugal during the maintenance treatment phase, using data from a drug dispensing nationwide database. This was a retrospective study that included a cohort from a patient-level hospital dispensing a Portuguese database of advanced therapies for IBD between april 2017-february 2022.
4200 patients followed in 18 Portuguese hospitals were included. In the first-line advanced therapies, 53.7% of the patients were on infliximab, 28.6% on adalimumab, 12.6% on vedolizumab, 3.7% on ustecinumab, 1.2% on golimumab and 0.2% in tofacitinib. 756 patients (18.0%) switched to another advanced therapy (second line). Of the patients that were in first-line and switched, 38% were on golimumab, 21.4% on vedolizumab, 19.7% on adalimumab, 17.1% on infliximab, and 1.3% on ustecinumab. More than 70% of all advanced therapies were dispensed according to the expected dispensing interval. 10.3% of the patients treated with infliximab and 23.7% treated with ustecinumab dispensed the drugs more frequently.
More than 80% of the patients with moderate to severe IBD were treated with anti-TNF-α therapy in the first-line. Most of the patients were on ustecinumab or vedolizumab in the second line. Although more than 70% of the patients had their drug dispensed, approximately ¼ of the patients treated with ustecinumab have a higher frequency of drug dispensing, showing that dose escalation could have a role in the Portuguese clinical practice.

Keywords: Inflammatory bowel disease, advanced therapies, real-world treatment, drug dispensing.