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Summary: Background: The expanding options in advanced therapies for ulcerative colitis (UC) and Crohn's disease (CD) present challenges in treatment selection. Persistence analysis assesses drug durability in real‐world settings, acting as a surrogate marker for medication efficacy and tolerance. Unlike traditional comparative studies, persistence analysis provides insights extending beyond the initial year of treatment. Aim: To provide real‐world evidence on treatment effectiveness, tolerability and preferences of physicians and patients regarding various advanced therapies for IBD. Methods: We conducted a systematic review of observational studies up to March 2023 assessing advanced therapies' persistence in UC and CD. Advanced therapies under examination included infliximab, adalimumab, vedolizumab, ustekinumab, golimumab, certolizumab and tofacitinib. We pooled the persistence of each agent and conducted a meta‐analysis to compare the persistence of newer agents with traditional TNF inhibitors (TNFi)—specifically infliximab and adalimumab. Results: Among 63 observational studies, vedolizumab had the highest 1‐year persistence in UC (73.8%, 95% CI: 70.0%–77.6%) and ustekinumab in CD (77.5%, 95% CI: 72.9%–82.1%). Compared to TNFi, vedolizumab demonstrated increased persistence with a relative risk (RR) of 1.30 (95% CI: 1.19–1.41) for UC and 1.14 (95% CI: 1.09–1.20) for CD at 1 year, while ustekinumab demonstrated a RR of 1.15 (95% CI: 1.07–1.23) for CD at 1 year. Vedolizumab exhibited sustained increased persistence in UC over 2 years compared to TNFi (RR: 1.33, 95% CI 1.14–1.54). Conclusion: This meta‐analysis highlights the superior persistence of ustekinumab and vedolizumab over TNFi, and offers valuable insights for clinicians navigating the challenging landscape of UC and CD therapeutic choices. [ABSTRACT FROM AUTHOR]

Background: The choice between infliximab (IFX) and vedolizumab (VED) as a first-line biological agent in moderate-to-severe ulcerative colitis (UC) can be difficult. Second-line vedolizumab (VED) efficacy may decline following prior infliximab (IFX) treatment failure in UC patients. However, it is not known whether second-line IFX efficacy declines after failure of first-line VED. Aims: We aimed to compare first-line and second-line persistence of IFX and VED, in particular whether second-line IFX persistence declines after failure of first-line VED. Methods: Persistence of IFX and VED was analysed from the Australian Pharmaceutical Benefits Scheme registry data as either first- or second-line treatment in UC. Propensity score matching (1:1) was conducted in the comparison of first-line treatments. Cox proportional hazard regression analysis was used to identify significant predictors and expressed as a hazard ratio (HR and 95% CI). Results: There were 420 subjects with moderate-to-severe UC who received either first-line IFX (n = 251) or VED (n = 169), with 774 patient-years of follow-up. First-line VED had significantly longer persistence than first-line IFX (>50.2 versus 22.2 months, p = 0.001). Fifty-three subjects failed first-line IFX and swapped to second-line VED (IFX→VED group). Twenty-two subjects failed first-line VED group and swapped to second-line IFX (VED→IFX group). First-line VED persistence was significantly longer than second-line VED (>50.2 versus 32.0 months, p = 0.03), but first-line IFX persistence was not statistically significantly different to second-line IFX (27.6 months versus > 38.6 months, p = 0.30). Immunomodulator co-therapy was significantly associated with a lower risk of nonpersistence of first-line VED (HR: 0.55, 95% CI: 0.33–0.89, p = 0.02) and IFX (HR: 0.63,95%CI: 0.33–0.92, p = 0.02). Conclusion: VED had a significantly longer persistence than IFX as first-line biological agent but does not disadvantage second-line IFX use in moderate-to-severe UC. VED after IFX is associated with significantly poorer persistence. VED, therefore, should be considered as the first-line biological agent of choice in UC. [ABSTRACT FROM AUTHOR]

Summary: Background: Medication persistence contributes real‐world evidence about treatment effectiveness, tolerability and prescriber and patient acceptability. Aims: To evaluate persistence of biological agents in Crohn's disease (CD) and ulcerative colitis (UC) and the effects of immunomodulator use and treatment lines. Methods: Retrospective national population‐based data on treatment persistence for adalimumab, infliximab vedolizumab and ustekinumab for CD and UC were analysed from the Australian Pharmaceutical Benefits Scheme using Kaplan‐Meier analysis and Cox proportional hazards models. Results: There were 2499 patients included with 8219 person‐years of follow‐up. In CD patients ustekinumab had increased persistence compared to anti‐TNF agents (HR: 1.79, 95%CI: 1.32‐2.38, P < 0.01). Twelve‐month CD persistence rates were ustekinumab 80.0%, vedolizumab 73.5%, infliximab 68.1% and adalimumab 64.2% (P = 0.01). In moderate‐severe UC vedolizumab had increased persistence compared to anti‐TNF agents (HR: 1.67, 95% CI: 1.27‐2.18 P < 0.001). Twelve‐month UC persistence rates were vedolizumab 73.4%, infliximab 61.1% and adalimumab 45.5% (P < 0.001). Immunomodulator co‐therapy did not significantly increase persistence in non‐anti‐TNF therapy (P > 0.05). Thiopurines increased persistence of anti‐TNF agents in CD (P < 0.001) and UC (P = 0.03). Methotrexate co‐therapy increased persistence of anti‐TNF agents in CD (P = 0.001) only. First‐line therapy was superior to non‐first line in persistence (P < 0.001). In fistulising CD, the persistence of infliximab and adalimumab was not significantly different (P = 0.11). Conclusion: Persistence was highest in ustekinumab in CD and vedolizumab in UC. Factors which increased the persistence of biological agents are first‐line therapy, and immunomodulator co‐therapy in anti‐TNF agent use. [ABSTRACT FROM AUTHOR]

Histologically, mesalazine-induced myocardial inflammation is associated with eosinophilic infiltration, whereas cases due to ulcerative colitis are characterised by lymphocytes.3,4 As an alternative, cardiac MRI is accurate and can identify myocardial fibrosis with late gadolinium enhancement often in subepicardial or mid-wall regions. Overall, the prognosis is excellent but both forms can be fatal.1 Generally, patients with mesalazine-associated myocardial inflammation have rapid improvement in left ventricular function upon cessation of therapy but inflammation can recur if rechallenged with mesalazine.1 On the other hand, ulcerative colitis-associated myocardial inflammation occurs irrespective of treatment and even though left ventricular function can improve, these patients are more likely to have late gadolinium enhancement on cardiac MRI.3 We present a case of perimyocarditis in a patient with acute severe ulcerative colitis treated with mesalazine. Learning points In patients with ulcerative colitis, perimyocarditis can be an extraintestinal manifestation of the condition or a hypersensitivity idiosyncratic reaction of treatment. [Extracted from the article]