P1607 - Demographics and Clinical Characteristics of Crohn’s Disease Patients Switched to a Non-Anti-TNF Agent After Initial Primary Non-Response With Anti-TNF Agent: A National Database Study

Muhammad Zarrar Khan, MD¹, Achintya D. Singh, MD¹, George Khoudari, MD¹, Motasem Alkhayyat, MD¹, Michael Delicce, MD¹, Mohannad Abou-Saleh, MD¹, Gregory Cooper, MD², Preetika Sinh, MD³, Fabio Cominelli, MD⁴, Yngve Falck-Ytter, MD⁵, Christopher Linz, MD⁵, Jeffry Katz, MD⁴, Miguel Regueiro, MD⁶, Emad Mansoor, MD^4
1Cleveland Clinic Foundation, Cleveland, OH; ²University Hospitals Case Medical Center, Cleveland, OH; ³Medical College of Wisconsin, Milwaukee, WI; ⁴University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; ⁵Louis Stokes Cleveland VA Medical Center, Cleveland, OH; ⁶Cleveland Clinic, Cleveland, OH

Introduction: Patients with Crohn’s disease (CD) that fail to respond to anti-TNF agents are frequently switched to non-anti-TNF agents like Vedolizumab (VEDO) or Ustekinumab (USK). However, the clinical characteristics of CD patients that are associated with an increased risk of primary non-response are unknown.

Aim: To investigate the clinical characteristics of CD patients switched to a non-anti-TNF agent after initial treatment with either Adalimumab (ADA) or Infliximab (IFX).

Methods: We queried a multi-center database (Explorys Inc, Cleveland, OH), an aggregated data from 26 major integrated healthcare systems in the US. Patients with a diagnosis of “Crohn’s disease” between December 2015 and 2020, based on Systemized Nomenclature of Medicine–Clinical Terms were identified. The demographic and clinical characteristics of patients started on either ADA or IFX then switched to a non-anti-TNF after at least 90 days to within 180 days of induction, to patients who were not switched (responders) were compared utilizing logistic regression.

Results: We identified 175,100 patients with CD in the database. Of these, 12,020 patients were started on ADA and 11,840 patients were started on IFX.

Table 1 shows the clinical characteristics of CD patients switched from ADA or IFX to USK or VEDO. Adults between age18-65 years were significantly associated with higher odds of class switching in either group. The presence of anal fissure significantly increased the odds of switching to VEDO, while those with a perianal abscess and who underwent drainage of perirectal abscesses were at higher odds of being switched to USK. Patients who underwent total colectomy were at significantly higher odds of being switched to either USK or VEDO.

In the IFX group, the presence of intestinal fistulae and small intestinal surgery had higher odds of class switching in both groups. CD patients with anal fissures or anorectal fistulae had significantly higher odds of switching to USK. While patients with drainage of abscess, total or partial colectomy had significantly higher odds of class switching to VEDO.

Discussion: We found patients with CD with severe phenotype (fistulizing, peri-anal disease) and history of CD-related surgery were at a higher risk of primary non-response to Anti-TNF agents requiring switch to VEDO or USK. Further exploration is required to determine if the severe CD phenotype is refractory to any medication and would benefit from surgery early after the failure of anti-TNF therapy.


Disclosures:


Muhammad Zarrar Khan, MD¹, Achintya D. Singh, MD¹, George Khoudari, MD¹, Motasem Alkhayyat, MD¹, Michael Delicce, MD¹, Mohannad Abou-Saleh, MD¹, Gregory Cooper, MD², Preetika Sinh, MD³, Fabio Cominelli, MD⁴, Yngve Falck-Ytter, MD⁵, Christopher Linz, MD⁵, Jeffry Katz, MD⁴, Miguel Regueiro, MD⁶, Emad Mansoor, MD⁴. P1607 - Demographics and Clinical Characteristics of Crohn’s Disease Patients Switched to a Non-Anti-TNF Agent After Initial Primary Non-Response With Anti-TNF Agent: A National Database Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.