Impact of Treatment Response on Risk of Serious Infections in Patients With Crohn's Disease: Secondary Analysis of the PYRAMID Registry

Dhruv Ahuja; Jiyu Luo; Yuchen Qi; Gaurav Syal; Brigid S Boland; John Chang; Christopher Ma; Vipul Jairath; Ronghui Xu; Siddharth Singh

doi:10.1016/j.cgh.2024.01.003

Impact of Treatment Response on Risk of Serious Infections in Patients With Crohn's Disease: Secondary Analysis of the PYRAMID Registry

Clin Gastroenterol Hepatol. 2024 Jun;22(6):1286-1294.e4. doi: 10.1016/j.cgh.2024.01.003. Epub 2024 Jan 11.

Authors

Affiliations

¹ Department of Medicine, Indira Gandhi Hospital, New Delhi, India.
² Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California.
³ Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California.
⁴ Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁵ Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
⁶ Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California. Electronic address: sis040@ucsd.edu.

PMID: 38216022
DOI: 10.1016/j.cgh.2024.01.003

Abstract

Background & aims: Traditional risk factors for serious infections with advanced therapies in patients with Crohn's disease (CD) have been assessed at baseline before starting therapy. We evaluated the impact of treatment response on the risk of serious infections in adalimumab-treated patients with CD through secondary analysis of the PYRAMID registry (NCT00524537).

Methods: We included patients with CD who initiated adalimumab and classified them as treatment responders (achieved steroid-free clinical remission based on patient-reported outcomes) vs nonresponders (not in steroid-free clinical remission) at 6 months after treatment initiation (landmark). We compared the risk of serious infections between responders vs nonresponders between 6 and 36 months after treatment initiation through stabilized inverse probability of treatment weighting Cox proportional hazards model.

Results: Of 1515 adalimumab-treated patients, 763 (50.4%) were classified as responders at 6 months (37 ± 13 y; 56% female; disease duration, 9.5 ± 8.5 y). Compared with nonresponders, responders were less likely to have moderate to severe symptoms (55.6% vs 33%), or require steroids (45.5% vs 17.3%) or opiates (6.6% vs 1.3%) at baseline, without any differences in disease location, perianal disease, and prior CD complications. During follow-up evaluation, using stabilized inverse probability of treatment weighting, responders were 34% less likely to experience serious infections compared with nonresponders (hazard ratio, 0.66; 95% CI, 0.46-0.96). Risk of gastrointestinal and extraintestinal infections was lower in responders vs nonresponders.

Conclusions: Patients with CD who respond to adalimumab have a lower risk of developing serious infections compared with nonresponders. These findings underscore that initiation of advanced therapy for CD may lower the risk of serious infections through effective disease control and avoidance of corticosteroids.

Keywords: Biologics; Comparative Effectiveness; IBD; Positioning; Safety.

MeSH terms

Adalimumab* / therapeutic use
Adult
Anti-Inflammatory Agents / therapeutic use
Crohn Disease* / complications
Crohn Disease* / drug therapy
Female
Humans
Infections / epidemiology
Male
Middle Aged
Registries*
Risk Assessment
Risk Factors
Treatment Outcome
Young Adult

Substances

Adalimumab
Anti-Inflammatory Agents

Associated data

ClinicalTrials.gov/NCT00524537