Which patients with inflammatory bowel disease should receive combination therapy?

Cross, Raymond K.

doi:10.1586/17474124.2015.1039989

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…Other studies did not assess the role of concomitant immunosuppressants 7 , 13 . Combination of anti-TNF agents and immunosuppressants may improve response 23 , 24 , but there are potential adverse events such as greater risk of infections and some malignancies 25 , 26 .…”

Section: Discussionmentioning

confidence: 99%

Real-life experience with 4 years of golimumab persistence in ulcerative colitis patients

Iborra

García-Morales

Rubio

et al. 2020

Sci Rep

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Golimumab has demonstrated its long-term efficacy and safety in ulcerative colitis in clinical trials, but no data of long-term persistence has been published from real world. To estimate long-term persistence of golimumab, as well as factors associated with longer persistence, in patients with ulcerative colitis in real life. Observational multicentre study including adult patients with ulcerative colitis treated with golimumab and with at least twelve months of follow-up. We included 190 patients, 105 (55.26%) naive to anti-TNF, with mean disease duration of 9.32 ± 8.09 years. Probability of persistence was 63%, 46%, 39% and 27% at 1, 2, 3 and 4 years, respectively. Persistence was lower in patients with primary failure to previous anti-TNF. Eighty-two (43.16%) patients needed dose intensification during follow-up, with a mean time until intensification of 8.03 ± 8.64 months. Dose intensification and lower disease duration predicted higher persistence with golimumab (p = 0.037 and p = 0.008, respectively). During a follow-up of 17.25 ± 15.83 months, 32 (16.5%) patients needed hospitalisation and 11 (6%) underwent colectomy. No unexpected adverse events were reported. Golimumab has demonstrated good persistence and safety profile for long treatment in ulcerative colitis patients.

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Section: Discussionmentioning

confidence: 99%

Real-life experience with 4 years of golimumab persistence in ulcerative colitis patients

Iborra

García-Morales

Rubio

et al. 2020

Sci Rep

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“…Recently, multiple publications have emphasized the importance of this concept in detail, and include such strategies as coadministration of corticosteroids and immunosuppressives, [31][32][33] treating to a specific objectively defined target (eg, endoscopic healing), 34 use of therapeutic drug monitoring, 25,35,36 and ensuring an adequate duration of therapy. 37,38 These specific strategies should be evaluated in future vedolizumab studies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Vedolizumab Induction and Maintenance Therapy in Patients With Ulcerative Colitis, Regardless of Prior Exposure to Tumor Necrosis Factor Antagonists

Feagan

Rubin

Danese³

et al. 2017

Clinical Gastroenterology and Hepatology

184

131

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Vedolizumab demonstrated significantly greater efficacy as induction and maintenance therapy for UC than placebo in patients naive to TNF antagonists and patients with TNF antagonist failure. There were numerically greater treatment differences at Week 6 among patients receiving vedolizumab who were naive to TNF antagonists than patients with TNF antagonist failure. ClinicalTrials.gov no: NCT00783718.

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“…Another matter to take into account is that treatments were considered in monotherapy, whereas it has been reported that a high percentage of patients being treated with vedolizumab take it in combination with azathioprine. This would increase the pharmacological cost of this alternative and could be linked to a higher risk of adverse events such as lymphoma, opportunistic infection, and nonmelanoma skin cancer [47]. Furthermore, it should be noted that the OCTAVE trials on tofacitinib featured a stricter definition of remission (with the additional requirement of a rectal bleeding subscore of 0) than that used in the studies on vedolizumab, and also required a centralized and therefore more demanding endoscopy reading [15].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of using innovative therapies for the management of moderate-to-severe ulcerative colitis in Spain

Taxonera

Andrés-Nogales

García-López

et al. 2021

Expert Review of Pharmacoeconomics & Outcomes Research

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Background: To evaluate the cost-effectiveness of tofacitinib in comparison to vedolizumab for the treatment of moderate-to-severe ulcerative colitis (UC) after failure or intolerance to conventional therapy (bio-naive) or first-line biologic treatment (bio-experienced), from the Spanish National Health System (NHS) perspective. Methods: A lifetime Markov model with eight-week cycles was developed including five health states: remission, response, active UC, remission after surgery, and death. Response and remission probabilities (for induction and maintenance periods) were obtained from a multinomial network meta-analysis. Drug acquisition -biosimilar prices included -(ex-factory price with mandatory deductions), administration, surgery, patient management, and adverse event management costs (€, year 2019) were considered. A 3% discount rate (cost/outcomes) was applied. Probabilistic and deterministic sensitivity analyses (PSA) were conducted. Results: Tofacitinib was dominant versus vedolizumab (both in bio-naive and bio-experienced patients) entailing total cost savings of €23,816 (bio-naïve) and €11,438 (bio-experienced). Differences in qualityadjusted life-year (QALY) were smaller than 0.1 for both populations. PSA results showed that tofacitinib has a high probability of being cost-effective (bio-naïve: 82.5%; bio-experienced: 90.6%) versus vedolizumab. Conclusions: From the Spanish NHS perspective, tofacitinib could be a dominant treatment (less costly and more effective) in comparison to vedolizumab, with relevant cost savings and similar QALY gains.

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Which patients with inflammatory bowel disease should receive combination therapy?

Cited by 4 publications

References 22 publications

Real-life experience with 4 years of golimumab persistence in ulcerative colitis patients

Real-life experience with 4 years of golimumab persistence in ulcerative colitis patients

Efficacy of Vedolizumab Induction and Maintenance Therapy in Patients With Ulcerative Colitis, Regardless of Prior Exposure to Tumor Necrosis Factor Antagonists

Cost-effectiveness analysis of using innovative therapies for the management of moderate-to-severe ulcerative colitis in Spain

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