Evidence map›Paper›PMID 39755922›Full record

ArticleDigestive diseases and sciences2025

Retrospective Cohort Study on the Predictive Value of Primary Non-response to Initial Biologic for Future Biologic Use in Patients with Inflammatory Bowel Disease.

Mahesh Krishna, Ellen J Spartz, Laura Maas, Vivy Cusumano, Sowmya Sharma, Berkeley Limketkai, Alyssa Parian

Abstract readEvaluation StudyMulticenter Study
PubMed Publisher
In one paragraph

Article in Digestive diseases and sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Mahesh KrishnaYale University School of Medicine, New Haven, CT, USA. mahesh.krishna@yale.edu.
Ellen J SpartzUCLA Health, Los Angeles, CA, USA.
Laura MaasJohns Hopkins University Department of Gastroenterology, Baltimore, MD, USA.
Vivy CusumanoUCLA Health, Los Angeles, CA, USA.
Sowmya SharmaJohns Hopkins University Department of Gastroenterology, Baltimore, MD, USA.
Berkeley LimketkaiUCLA Health, Los Angeles, CA, USA.
Alyssa ParianJohns Hopkins University Department of Gastroenterology, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe armamentarium of medical therapies to treat inflammatory bowel disease (IBD) continues to grow, which has expanded treatment options, particularly after first biologic failure. Currently, there are limited studies investigating the predictive value of first biologic primary non-response (PNR) on subsequent biologic success. Our objective was to determine if PNR to the first biologic for IBD is predictive of response to subsequent biologic therapy.

methodsA multicenter retrospective chart review study was performed with patients with IBD that received two or more biologics. PNR was defined as no clinical or symptomatic improvement after at least six weeks of treatment leading to cessation of drug. Patients who stopped their first biologic due to adverse side effects were classified in the intolerance group. Patients with initial significant response to biologic followed by a loss of response were classified as secondary loss of response (SLOR). Data analysis was performed with Python and Excel.

resultsOf the 249 patients that met inclusion criteria, there were 87 patients with PNR, 96 patients with SLOR, and 66 patients with intolerance to their first biologic exposure. Patients with ulcerative colitis (UC: 41.3%, p = 0.0083) and IBD-unclassified (IC: 56.3%, p = 0.0099) were found to have a significantly higher rate of primary non-response compared to patients with Crohn's disease (CD: 25.0%). Patients on adalimumab for their first biologic had a significantly (p = 0.0014) higher rate of PNR (42.7%, UC: 50.0%, CD: 32.7%) compared to those on infliximab (23.0%, UC: 31.0%, CD: 12.1%). Patients with PNR did not have a higher rate of second biologic nonresponse when compared to patients who had SLOR or intolerance to their first biologic. Univariate analyses demonstrated no difference in rates of response to second biologic when switching intra-class or out-of-class.

conclusionUlcerative colitis and IBDU have higher rates of PNR compared to Crohn's disease, but still have high response rates to second biologic agents. Adalimumab may be a suboptimal initial biologic given its higher PNR rate compared to infliximab. Our results support that there is an equally likely chance of response to second biologic after first biologic PNR. Subanalyses evaluating intraclass and out-of-class medication switching showed similar success.

Indexed as

Biological ProductsColitis, UlcerativeCrohn DiseaseGastrointestinal AgentsInflammatory Bowel DiseasesAdalimumabAdultFemaleHumansInfliximabMaleMiddle AgedPredictive Value of TestsRetrospective StudiesTreatment FailureTreatment OutcomeAdalimumabBiological ProductsGastrointestinal AgentsInfliximabBiologicsPrimary non-responseResponseSecondary loss of responseTumor necrosis factor inhibitor

Identifiers

PMID39755922

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.