Real-Life Use of Subcutaneous Biologicals and JAK Inhibitors in IBD Maintenance Therapy: Treatment Continuation,...

Combining biologicals or Janus kinase inhibitors (JAKis) with conventional medications and switching therapies is common in moderate-to-severe inflammatory bowel disease (IBD) treatment. This study assessed the use of conventional medications, treatment continuation, switching, and factors associated with switching during IBD maintenance therapy with subcutaneous (SC) biologicals or JAKis.

This Finnish nationwide, retrospective registry study included adult Crohn's disease (CD) and ulcerative colitis (UC) patients on SC biological/JAKi maintenance therapy (≥6 months on treatment) during 2003-2023. Pharmacy dispensation data were collected from The Social Insurance Institution.

Among 7,707 individuals, use of corticosteroids (CS), immunosuppressants (IS) and 5-aminosalicylates (5-ASA) was less common after SC biological/JAKi initiation. At 24 months, treatment continuation rates were 51-57% for adalimumab, golimumab, ustekinumab and tofacitinib (in UC); and 71-80% for infliximab, vedolizumab and ustekinumab (in CD). Overall, 16% of treatments were switched-most commonly from golimumab (28%), tofacitinib (24%) and adalimumab (21%) to ustekinumab (42% of switches) or vedolizumab (17% of switches). Prior golimumab (adjusted OR, 1.73; 95% CI, 1.42-2.09) or tofacitinib (1.48; 1.16-1.86) use was associated with a higher risk of switching (p<0.001), while prior infliximab (0.12; 0.09-0.16), vedolizumab (0.35; 0.26-0.46), IS (0.52; 0.45-0.57), or 5-ASA (0.62; 0.55-0.70) use was associated with lower risk (p<0.001).

Treatment continuation rates during maintenance reached up to 80%. Most switches involved a different mode-of-action. While conventional medications were tapered, IS and 5-ASA may support treatment continuation.