Background Treatments for inflammatory bowel diseases (IBD) have evolved in the era of biologics. However, the real-world data on their usage patterns and sequencing are still limited. Objectives We aimed to investigate treatment persistence and dose intensification of first- and second-line biologics in patients with IBD. Design In this retrospective, cohort study using nationwide claims data, 13,087 patients with IBD initiating biologic therapy between 2010 and 2020 were identified. Methods Treatment persistence and dose intensification during the first 2 years and switching patterns of biologics were analysed while identifying predictors of non-persistence. Results As a first-line treatment of Crohn's disease (CD), ustekinumab had a lower risk for non-persistence compared to infliximab [adjusted hazard ratio (aHR), 0.69, p = 0.048]. Second-line ustekinumab and vedolizumab showed the highest and lowest persistence (79.2% and 54.9%), respectively. As a first-line treatment of ulcerative colitis (UC), golimumab had a higher risk for non-persistence compared to infliximab (aHR, 1.68, p < 0.001). Second-line golimumab also showed a significantly lower persistence rate than adalimumab and vedolizumab. The risk of non-persistence was higher in UC than in CD (first line: aHR, 1.97; second line: aHR, 1.39; p < 0.001), and in the second-line treatment than in the first-line treatment for CD (aHR, 1.55; p < 0.001). The cumulative rate of dose intensification was highest with ustekinumab for CD (first line, 43.3%, second line, 69.1%) and adalimumab for second-line UC (40.7%). It was significantly increased in second-line therapy in CD, but not in UC. Among switchers of first-line anti-tumour necrosis factor-α inhibitor therapy, after all biologics were approved, 69% of CD patients and 78.4% of UC patients switched to other classes of second-line treatment. Conclusion Ustekinumab had higher persistence in the first-line treatment of CD, while golimumab had lower persistence for first- and second-line treatments of UC. Dose intensification rates varied, with the highest cumulative rates observed for ustekinumab in CD and adalimumab in second-line UC.

中文翻译：

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炎症性肠病患者 10 年生物制剂使用模式：治疗持续性、转换和剂量强化 - 一项全国性人群研究。

背景 炎症性肠病 (IBD) 的治疗方法在生物制剂时代不断发展。然而，有关其使用模式和排序的真实数据仍然有限。目的 我们旨在研究 IBD 患者一线和二线生物制剂的治疗持续性和剂量强化。设计 在这项使用全国索赔数据的回顾性队列研究中，确定了 2010 年至 2020 年间开始生物治疗的 13,087 名 IBD 患者。方法 分析前 2 年的治疗持续性和剂量强化以及生物制剂的转换模式，同时确定非持续性的预测因素。结果 作为克罗恩病 (CD) 的一线治疗药物，与英夫利昔单抗相比，乌特克单抗的不持续风险较低 [调整后风险比 (aHR)，0.69，p = 0.048]。二线乌特克单抗和维多珠单抗的持久性分别最高和最低（79.2% 和 54.9%）。作为溃疡性结肠炎 (UC) 的一线治疗药物，与英夫利昔单抗相比，戈利木单抗的不坚持风险更高（aHR，1.68，p < 0.001）。二线戈利木单抗的持续率也显着低于阿达木单抗和维多珠单抗。UC 中非持续治疗的风险高于 CD（一线：aHR，1.97；二线：aHR，1.39；p < 0.001），并且 CD 的二线治疗高于一线治疗（ aHR，1.55；p < 0.001）。治疗 CD 的乌特克单抗（一线，43.3%，二线，69.1%）和二线 UC 的阿达木单抗（40.7%）的累积剂量强化率最高。在 CD 的二线治疗中显着增加，但在 UC 中则没有。在一线抗肿瘤坏死因子-α抑制剂治疗的转用者中，在所有生物制剂获得批准后，69%的CD患者和78.4%的UC患者转用其他类别的二线治疗。结论 乌司奴单抗在 CD 一线治疗中具有较高的持久性，而戈利木单抗在 UC 一线和二线治疗中的持久性较低。剂量强化率各不相同，其中乌特克单抗治疗 CD 的累积率最高，阿达木单抗治疗二线 UC 的累积率最高。