More than 1,000 medical records of IBD patients who switched biologics for either Crohn’s disease or ulcerative colitis were included in the analysis. One hundred eighty-seven gastroenterologists took part in the review. A biologic is a therapy derived from a biological source rather than chemicals.
The report showed that Stelara, which blocks the inflammatory molecules IL-12 and IL-23, is now the most preferred second-line drug that does not target tumor necrosis factor (TNF). Takeda’s Entyvio (vedolizumab) was the second-line leader last year. Tumor necrosis factor is a cell signaling protein implicated in a number of diseases, including IBD.
TNF blockers remain the most popular treatment choice for bowel disease, the report indicated. Many doctors have struck with an approach of prescribing a second TNF blocker when the first fails.
But more doctors have prescribed second-line drugs that target other molecules since 2016, the report said.
The main reason why gastroenterologists recommend that patients switch drugs is failure to meet treatment goals, according to the report. When patients are unable to meet their goals, their physicians switch 70 percent of them to a new therapy within six months, it said.
So far, regulators have approved Stelara only for Crohn’s disease. But doctors are also using it to treat ulcerative colitis, the report added.
Although Entyvio remains the top non-TNF-targeting second-line drug, the report predicts that Stelara will become the choice of nearly a third of patients who switch from a second to a third biologic drug.
Many of the gastroenterologists who participated in the report said patients often take an active part in the decision to switch drugs, and are sometimes the main driver of the decision.
Another finding was that there is a trend for physicians to increase prescriptions of biologics. This includes using them earlier and switching them faster. Doctors are also more willing to try drugs that act in new ways, stepping away from the older TNF blockers.
Although a few drugs dominate today’s treatments, gastroenterologists said nearly half of their patients fail to respond to them in an optimal way. This opens the door to newcomers such as Pfizer‘s Xeljanz (tofacitinib citrate), Celgene‘s mongersen and ozanimod, and Roche/Genentech‘s etrolizumab playing important treatment roles.