Vimal Bodiwala, MD1, Timothy Marhsall, PhD, MS, ACSM/ACS-CET2, Darren Seril, MD, PhD1
1Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; 2Kean University, New Brunswick, NJ
Introduction: The aim of this study was to compare the efficacy and adverse effects of biological therapies in South Asian patients with Crohn’s disease (CD) and ulcerative colitis (UC) living in the United States with those of a Caucasian American cohort.
Methods: The efficacy, reasons for therapy discontinuation, and adverse effects of biological therapies in 73 South Asian patients (31 CD and 42 UC) who presented initially to our tertiary referral center from 2012 to 2016 and had subsequent follow-up were retrospectively compared with those of 408 consecutive Caucasian American patients (245 CD and 163 UC). The reasons for biologic therapy discontinuation were classified as: financial barrier, clinician judgment based on disease remission, primary non-response, secondary non-response, adverse effects, and patient preference. Adverse effects for biologic agents were classified as injection site reaction, infusion reactions, cytopenia, secondary infections, neurologic effects (including demyelinating disease or vestibular issues), cardiac effects (including heart failure), cutaneous effects, malignancy, and others.
Results: For both the South Asian and Caucasian American cohorts, adalimumab and infliximab were the most commonly prescribed biologic agents. Twenty-two out of 22 (100%) South Asian CD patients treated with adalimumab or infliximab had primary response. The Caucasian American CD cohort had a primary non-response rate of 16.5% to adalimumab and 12.1% to infliximab (Table 1). There was no statistical difference noted in the incidence of secondary non-response due to immunogenicity between South Asian and Caucasian American CD patients. Primary non-response, secondary non-response and adverse effects were the leading reasons for discontinuing biological therapy in both UC cohorts (Table 2). South Asian and Caucasian American CD patients experienced similar rates of adverse effects to anti-TNF therapy (Table 3). South Asian UC patients had a higher rate of primary non-response and a lower rate of adverse events with infliximab therapy compared to Caucasian American UC patients (Table 3).
Discussion: A cohort of South Asian IBD patients, mainly migrants, showed differing rates of response and adverse effects to biological therapies compared to a Caucasian American cohort. Of note, South Asian CD patients had higher rates of primary response to anti-TNF therapy than Caucasian American CD patients. These results provide insights into ethnic and racial variation in IBD therapeutics.
Citation: Vimal Bodiwala, MD; Timothy Marhsall, PhD, MS, ACSM/ACS-CET; Darren Seril, MD, PhD. P2304 - COMPARING EFFICACY AND ADVERSE EFFECTS OF BIOLOGICAL AGENTS IN SOUTH ASIAN INFLAMMATORY BOWEL DISEASE PATIENTS LIVING IN THE UNITED STATES TO CAUCASIAN AMERICAN PATIENTS. Program No. P2304. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.