P0957 Flow of Advanced Therapy Pathways and Variations over Time in Crohn’s Disease and Ulcerative Colitis: Data from the Persistence Australian National IBD Cohort (PANIC5)
Authors: Pan F Y , Pudipeddi P , Chetwood J , Choi C H , Leong R 
Published: January 2025

Abstract

Background
Choice of advanced therapy (AT) in Crohn’s disease (CD) and ulcerative colitis (UC) have increased, however the optimal positioning and sequencing of agents are unknown. We present the first national data on sequencing for all AT treatments in Australia with Sankey diagrams.

Methods
We analysed the Persistence Australian National IBD Cohort (PANIC) 5 registry, including all UC and CD patients on AT via the Pharmaceutical Benefits Scheme up to December 2021. Sankey diagrams were created using Plotly, a Python-based tool. Each AT was coded as a node along the x-axis, and the y-axis represented patients’ treatment pathways, including sequential switches and stops from first to fifth-line treatments. Patients were divided into tertiles based on first AT commencement date (T1, T2, and T3) for both UC and CD data, and trends across these periods were compared. Statistical analyses were performed using SPSS.

Results
In a cohort of 9,671 UC patients (23,220 patient-years), 45% (n=539) discontinued first-line treatment in T1, which was 2.8 times more likely compared to 16% in T3 (p &lt; 0.001). Additionally, 15% of patients in T1 transitioned to a second advanced therapy (AT), whereas 35% did so in T3 (p &lt; 0.001). TOF was less frequently used in bio-naïve patients but more commonly prescribed in bio-exposed patients. Notably, in T3, TOF was the only therapy to show a significant increase in use from first- to fifth-line treatment, with the number of patients rising from 84 to 330, a 293% increase.
In a cohort of 19,087 CD patients (79,677 patient-years), 48% (n=1465) discontinued first-line TNFi treatment in T1, making them 2.1 times more likely to stop treatment compared to T3 (p &lt; 0.001). Due to limited treatment options in T1, only 20% of patients transitioned to second-line advanced therapy (AT), compared to 38% in T3. Furthermore, with the introduction of UST in T3, it was 2.1 times more likely to be prescribed to bio-exposed patients than ADA, the second most commonly used therapy in this group during T3.

Conclusion
This study underscores the increasing diversity of AT pathways for IBD patients, resulting in improved treatment retention over time. In both Crohn’s disease and ulcerative colitis, patients in T3 were less likely to discontinue treatment compared to those in T1, largely due to the expanded use of TOF and UST as salvage therapies. These findings provide important insights into the optimal sequencing of AT in IBD, demonstrating that a broader array of treatment options enhances patient adherence by offering more effective salvage strategies.

References
Ko Y, Paramsothy S, Yau Y, Leong RW. Superior treatment persistence with ustekinumab in Crohn’s disease and vedolizumab in ulcerative colitis compared with anti-TNF biological agents: real-world registry data from the Persistence Australian National IBD Cohort (PANIC) study. Aliment Pharmacol Ther. 2021 Aug;54(3):292-301. doi: 10.1111/apt.16436. Epub 2021 Jun 20. PMID: 34151447.