Trends in the use of biologic agents and their persistence rates in inflammatory bowel disease in India.

BACKGROUND: Biologic agents revolutionized the treatment of inflammatory bowel disease (IBD), yet their usage rates in India have historically been among the lowest globally. This is primarily attributed to cost. Data is scarce regarding the proportion of Indian patients with IBD needing biologics, actually receiving them and the persistence with therapy. AIM: To evaluate the proportions of patients with IBD needing a biologic agent, receiving it, continuing or discontinuing it and reasons for these. METHODS: This observational cohort study enrolled 697 patients with IBD from a single center: 297 patients in a prospective arm and 400 patients in a retrospective arm. Demographic data and data on the need for biologics, receipt of therapy, duration of use and specific reasons for discontinuation were recorded. RESULTS: Biologics were indicated in 95 (31.9%) patients in the prospective arm and 16 (4%) in the retrospective arm. In the former, 80 (26.9%) patients received biologics whereas in the latter 13 (3.2%) received it. On follow-up, 51 (17.1%) in the prospective arm and 10 (2.5%) in the retrospective arm continued biologics for median duration of 13.5 (IQR 44) months and 18.5 (IQR 23) months, respectively. Major reasons for discontinuation in the prospective cohort included primary non-response and secondary loss of response (31%), whereas the retrospective arm was driven by non-affordability. CONCLUSION: About 16% (111/697) of our patients with IBD needed biologics; of these, 16% (18/111) did not receive it. About a third of patients discontinued it. Strategies must focus on cost reduction and optimizing the use of biologics.