Early Biologic Therapy After Crohn Disease Diagnosis May Decrease Adverse Outcomes

The risk for disease progression or undergoing surgical procedures is lower among patients with Crohn disease who start biologic therapy early after diagnosis.

Starting treatment with biologic therapy soon after receiving a Crohn disease (CD) diagnosis is associated with a decreased risk for disease progression and need for surgical procedures compared with patients who start treatment later in the disease course, according to study results presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2022 conference, held from December 5 to 7, 2022, in Orlando, Florida.

The TARGET-IBD study was a prospective, longitudinal study conducted at 34 sites in the United States between 2016 and 2022. Patients (N=4474) with inflammatory bowel disease (IBD) who initiated treatment with biologic therapies were evaluated for IBD surgical procedures and disease progression on the basis of biologic initiation timing postdiagnosis. Biologic therapies were defined as vedolizumab, ustekinumab, and anti-tumor necrosis factor (TNF) therapies like adalimumab, infliximab, and certolizumab pegol. Disease progression was defined as a change in CD phenotype from B1 to B2/3.

Among the entire TARGET-IBD cohort, 611 had CD and initiated biologic therapy during follow-up.

The risk for undergoing surgical procedures was higher in patients who initiated biologic therapy later in the disease course. Nearly a third (30%) of the patients who initiated biologic therapy between 2 and 5 years after their CD diagnosis underwent surgical procedures within 20 months of diagnosis. This rate was significantly higher than what was observed among patients who initiated biologic treatment earlier in their disease course.

CD patients who began biologics closer to their diagnosis had a lower risk of surgery as well as disease progression, supporting the importance of biologic use early in the management of patients with CD.

The risk for disease progression was lower in patients who started biologic therapy early. Among patients who initiated biologic therapy within 1 month of CD diagnosis, 15% experienced progression in their disease. By contrast, approximately 50% of patients who initiated biologic therapy between 2 and 5 years after diagnosis experienced disease progression by 20 months. By month 60, almost 60% of patients who initiated biologic therapy between 2 and 5 years after diagnosis experienced disease progression.

“In a comparison of time to initiating a biological therapy, CD patients who began biologics closer to their diagnosis had a lower risk of surgery as well as disease progression, supporting the importance of biologic use early in the management of patients with CD,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Long M, Dubinsky M, Regueiro M, et al. The impact of early vs late biologic initiation among real-world patients with Crohn’s diease in TARGET-IBD. Abstract presented at: AIBD 2022; December 5-7, 2022; Orlando, FL. Abstract 31.