Treatment trajectories and outcomes in inflammatory bowel disease: a tertiary single-centre experience

Abstract

Background: There is an increasing diversification in the treatment landscape for inflammatory bowel diseases (IBD) leading to therapeutic challenges that can only incompletely be covered by prospective randomized double-blind trials. Real-world observations are therefore an important tool to provide insights into therapeutic strategies. Objectives: To describe the real-world treatment algorithms in an IBD referral centre. Design: Single-centre retrospective cohort study. Methods: We retrospectively analysed prospectively collected data on treatment sequences and outcomes from 502 patients with Crohn’s disease (CD) and ulcerative colitis (UC) treated with infliximab, adalimumab, vedolizumab or ustekinumab at a large German tertiary referral centre. Results: Treatment decisions correlated to baseline patient characteristics. Over time, infliximab continued to be the preferred first-line option in CD and UC, although ustekinumab and vedolizumab, respectively, became increasingly important choices. Remission rates decreased with the advancement of therapy lines. Conclusion: We provide insights into the evolution of tertiary centre real-world treatment sequences that might – together with other observations – help to guide the selection of therapies in IBD. Our data also strongly underscore the unmet need for biomarkers supporting treatment decisions. Trial registration: None.